bluuebunny/crossref_metadata_2025 huggingface dataset:
Complementary and alternative therapies for non-alcoholic fatty liver disease
Authors: Zhang Tiefeng , Han Duan , Zhang Tianqi , Jing Cai , Sun Jianguang
Published: January 2021

Background:

Non-alcoholic fatty liver disease (NAFLD) has become a global pandemic, and its incidence is increasing year by year. At present, there are no definite curative drugs for the treatment of NAFLD in modern medicine. Surprisingly, complementary and alternative therapies play an important role and have special advantages. In this study, we will adopt Bayesian network meta-analysis (NMA) to evaluate the efficiency and safety of complementary therapy and alternative therapies for NAFLD.

Methods:

We will collect randomized controlled trials (RCTs) related to the treatment of NAFLD in PubMed, Cochrane Library, CNKI, and other databases. Two reviewers will screen the literature and extract data in line with the inclusion and exclusion criteria, and then assess the risk of bias according to Cochrane risk of bias assessment tool. The Bayesian NMA will be performed by Stata16.0 and WinBUGS1.4.3.

Results:

Our study will compare and rank the efficacy and safety of diverse complementary and alternative therapies for NAFLD.

Conclusion:

This study can provide credible evidence for the efficacy and safety of complementary therapies and alternative therapies in the treatment of NAFLD. We expect to assist clinicians and patients to choose the optimal therapeutic regimen.

Protocol registration number:

INPLASY2020120136.
Effects of Taijiquan on glucose and lipid metabolism in middle-aged and elderly diabetic patients
Authors: Liu Ya-Nv , Wang Lin , Fan Xin , Liu Shijie , Wu Qi , Qian You-Lin
Published: January 2021

Background:

The improvement effect of exercise on diabetes mellitus has been widely recognized. Taijiquan, as a popular exercise mode for middle-aged and elderly people, is not clear about its effect on glucose and lipid metabolism in elderly diabetic patients. In this paper, the influence of Taijiquan on glucose and lipid metabolism in middle-aged and elderly diabetic patients was studied by using a meta-analysis method, to provide evidence for the clinical promotion of Taijiquan to improve glucose and lipid metabolism in diabetic patients.

Methods:

Computer system search and manual search were conducted respectively in web of science, PubMed, Cochrane Library, EMBASE, Google Scholar, China National Knowledge Infrastructure, Wanfang Database, VIP from the inception to August 1, 2020. Randomized controlled trials of the application of Taijiquan in middle-aged and elderly diabetic patients were collected.

Results:

The current study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program.

Conclusion:

This review aims to study the effect of Taijiquan on the glucose and lipid metabolism of middle-aged and elderly diabetic patients, objectively evaluate the effect of Taijiquan on the glucose and lipid metabolism of middle-aged and elderly diabetic patients, and provide scientific basis for clinical exercise intervention in middle-aged and elderly diabetic patients.

Protocol registration number:

INPLASY2020120107
Comparison of clinical efficacy of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura
Authors: Zhu Quan-Li , Wu Wei
Published: January 2021

Background:

The purpose of this study is to compare the clinical efficacy of laparoscopic splenectomy (LS) and open splenectomy (OS) in the treatment of Idiopathic thrombocytopenic purpura.

Methods:

We systematically searched PubMed, Web of science, EMBASE, Clinicaltrials.gov, and Cochrane Central Register for studies (study published from July 1992–January 2020). This study analyzed the clinical effect of LS and OS on idiopathic thrombocytopenic purpur.

Results:

This study showed that compared with OS, the LS's Overall response (OR: 0.60, 95% confidence interval (CI): 0.23–1.59, P = .30), Complication (OR: 0.59, 95% CI: 0.18–1.94, P = .38), Accessory spleen(OR: 1.70, 95% CI: 0.98–2.98, P = .06), Wound infections (OR: 0.65, 95% CI: 0.26–1.59, P = .34), Pancreatic fistula (OR: 0.73, 95% CI: 0.16–3.30, P = .68), was no significant, the Operative time (weighted mean difference (WMD): 49.33, 95% CI: 36.29–62.37, P < .00001)was longer, and the Estimated blood loss (WMD: –172.59, 95% CI: –319.96 to –25.22, P = .02), Postoperative length of stay (WMD: –4.68, 95% CI: –7.75 to –1.62, P = .003)was less.

Conclusions:

The therapeutic effect of LS was the same as that of OS in Overall response Complication Accessory spleen, while The operative time was longer, the Estimated blood loss was less, and the postoperative length of stay was shorter.
Integrated Traditional Chinese and Western medicine for ulcerative colitis with diabetes
Authors: Lan Yu-Ze , Bai Ya-Li , Zhu Xiang-Dong
Published: January 2021

Background:

This study aimed to access the efficacy and safety of integrated Traditional Chinese and Western medicine treatment for patients with ulcerative colitis (UC) combined diabetes.

Methods:

This protocol adheres to the preferred reporting items for systematic reviews and meta-analysis protocol statement. We plan to search 8 electronic databases to identify qualifying studies published from database inception until December 1, 2020. The software of EndNote reference manager (X9) will be used to study selection. A pre-developed standardized data collection form will be used to extract from all eligible studies. For included studies, the quality will be assessed by Cochrane Risk of bias tool. The RevMan 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) developed by the Cochrane Collaboration will be used for all statistical analysis. If possible, meta-analysis will be undertaken for each of the outcomes. For continuous variable data, we will used mean differences with 95% confidence intervals (CIs) as summary statistics. For dichotomous variable data, we will calculate Mantel-Haenszel odds ratio with 95% CIs as summary statistics from the numbers of events in control and intervention groups. We will consider a result to be statistically significant if P < .05. If outcomes cannot be meta-analyzed, we will performer a descriptive analysis.

Results:

This study will be performed to test the efficacy and safety of integrated Traditional Chinese and Western medicine treatment for patients with UC combined diabetes.

Conclusion:

The results of our study will be published in a peer-reviewed journals, and we will promotion results in domestic and foreign conferences.

Registration number:

INPLASY2020120087

Ethics and dissemination:

As a systematic review and meta-analysis which based on previously published literature, ethical approval, and informed consent from patients are not required.
Effects of mind-body exercise on PTSD symptoms, depression and anxiety in PTSD patients
Authors: Zhu Lin , Li Long , Li Xiao-zhi , Wang Lin
Published: January 2021

Background:

The present study aimed to systematically analyze the effects of mind-body exercise on PTSD symptom, depression and anxiety among patients with post-traumatic stress disorder (PTSD) and to provide a scientific evidence-based exercise prescription. Meanwhile, it will also help reduce the global mental health burden of COVID-19.

Methods:

Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 to September 2020 relating to the effects of mind-body exercise on PTSD symptom, depression and anxiety in PTSD patients.

Conclusion:

This systematic review and meta-analysis will provide stronger evidence on the effectiveness and safety of mind-body exercise for PTSD symptoms in PTSD patients.

Systematic review registration:

INPLASY2020120072.
Severe laryngeal edema caused by Pseudoterranova species
Authors: Suzuki Shiori , Bandoh Nobuyuki , Goto Takashi , Uemura Akihiro , Sasaki Mizuki , Harabuchi Yasuaki
Published: January 2021

Rationale:

Severe laryngeal edema can cause upper airway obstruction, which is fatal. Pseudoterranova, an uncommon nematode of the family Anisakidae, predominantly invades the stomach after ingestion of the nematodes in raw or undercooked marine fish. There have been a few reports of development of severe laryngeal edema caused by the nematode invading the base of the tongue.

Patient concerns:

A 69-year-old Japanese woman complained of stuffy and scratchy throat for 8 hours and reported eating sashimi, fresh slices of raw jacopever, 4 days before the first visit.

Diagnosis:

Endoscopy revealed a white-yellowish wriggling worm at the left side of the base of the tongue and severe edema of the larynx.

Interventions:

The worm was extracted using endoscopic forceps. The patient was hospitalized and treated with intravenous injection of an antibiotic and steroid.

Outcomes:

The symptoms and laryngeal edema disappeared the next day. The worm was identified as a 4th-stage larva of Pseudoterranova spp based on morphologic features. The serum Anisakis-specific IgE antibody level was high, at 38.6 UA/mL.

Lessons:

Clinicians should be aware of the possibility of severe laryngeal edema due to invasion by anisakid nematodes in the pharyngolaryngeal area in cases involving previous ingestion of raw or uncooked marine fish.
Mixed response and mechanisms of resistance to larotrectinib in metastatic carcinoma ex pleomorphic adenoma of the parotid harboring an NTRK2 fusion
Authors: Pircher Magdalena , Briner Hans Rudolf , Bonomo Marco , Horcic Milo , Petrausch Ulf , Helbling Daniel , Winder Thomas
Published: January 2021

Introduction:

Standardized systemic treatment options are lacking for carcinoma ex pleomorphic adenoma, which is a rare and aggressive tumor primarily found in salivary glands.

Here we report the case of a 63-year-old male with carcinoma ex pleomorphic adenoma of the left parotid and parapharyngeal space harboring a neurotrophic receptor tyrosine kinase (NTRK) 2 fusion who was treated with a small molecule inhibitor that targets the tropomyosin receptor kinase (TRK) proteins. To the best of our knowledge, no similar case has been described in the literature so far.

Patient concerns:

After multiple surgical resections and radiotherapy for localized cancer disease over several years, our patient again developed an increasing swelling and pain around the left ear and numbness of the left half of the face.

Diagnosis:

Magnetic resonance imaging and positron emission tomography/computed tomography scans showed tumor recurrence in the left parotid, below the left ear, and in the parapharyngeal space, as well as metastases of the lungs and cervical lymph nodes. As data on the efficacy of systemic therapies for inoperable carcinoma ex pleomorphic adenoma are scarce, we performed a next-generation sequencing that revealed the presence of a hitherto unknown NTRK2 fusion.

Interventions:

Treatment with the TRK inhibitor larotrectinib was initiated, which induced rapid symptom improvement. However, part of the tumor had to be removed shortly afterwards due to local progression. Molecular testing did not demonstrate any alterations accounting for resistance to larotrectinib, with maintenance of the NTRK2 fusion.

Outcomes:

Three months later, imaging confirmed mixed response. While the reason for this remains unknown, the patient is in good condition and continues to receive larotrectinib.

Conclusion:

It remains unclear why our patient showed mixed response to larotrectinib and further studies are needed to explore other possible mechanisms of resistance.
Early-phase pelvic bone SPECT
Authors: Ayoubi Jacob , Guendouzen Sofiane , Morland David
Published: January 2021

Tomoscintigraphic reconstruction in nuclear medicine assumes that the distribution of the tracer is unchanged in the volume of interest throughout the duration of the acquisition. This condition is however not met in early-phase bone scintigraphy and early-phase pelvic SPECT may display helical artifacts due to the filling of the bladder. Those artifacts may hamper proper interpretation of surrounding bone areas. The aim of this study was to construct a 4D digital pelvic phantom to simulate different acquisition protocols and optimize the acquisition.

A 4D digital pelvic phantom was generated with a dynamic component consisting in an expanding bladder with 2 ureters and a static part consisting in the 2 kidneys, bone structures, and soft tissues. Projection data were obtained using an attenuated Radon transform function. Four acquisitions protocols were tested: 32 projections of 16 seconds (32–16–1), 32 projections of 8 seconds (32–8–1), 2 consecutive SPECT of 32 projections of 4 seconds (32–4–2) and 2 consecutive SPECT of 16 projections of 8 seconds (16–8–2). The optimal protocol was then tested on one patient.

The amplitude of the artifacts was reduced with the 32–8–1, 32–4–2, and 16–8–2 protocols. The 16–8–2 protocol had the highest signal to noise ratio among those 3 protocols. The bladder artifact was visually markedly reduced on the patient acquisition with a 16–8–2 protocol.

Two successive early-phase bone SPECT, with a lower number of projection than the usual protocol reduce the impact of the helical artifacts around the bladder.
The modified water swallowing test score is the best predictor of postoperative pneumonia following extubation in cardiovascular surgery
Authors: Oguchi Natsuko , Yamamoto Shuhei , Terashima Satsuki , Arai Ruka , Sato Masaaki , Ikegami Shota , Horiuchi Hiroshi
Published: January 2021

No guidelines have been established for the evaluation of swallowing function following extubation. The factors of bedside swallowing evaluations (BSEs) that are associated with the development of pneumonia have not been fully elucidated. This study aimed to retrospectively investigate the most appropriate measurements of BSEs for predicting pneumonia.

The study subjects were 97 adults who underwent BSEs following cardiovascular surgery. Patients were divided into the pneumonia onset group (n = 21) and the non-onset group (n = 76). Patient characteristics, intraoperative characteristics, complications, BSE results, and postoperative progress were compared between the groups. BSEs were composed of consciousness level, modified water swallowing test (MWST) score, repetitive saliva swallowing test score, speech intelligibility score, and risk of dysphagia in the cardiac surgery score. Univariate and multivariate analyses with the BSE as the independent variable and pneumonia onset as the dependent variable were also performed to identify factors that predict pneumonia. For factors that became significant in univariate analysis, the incidence of pneumonia was shown using the Kaplan-Meier curve.

No significant differences were found in patient characteristics, intraoperative characteristics, and complications between the 2 groups. The postoperative progress was significantly different between the 2 groups, the pneumonia-onset group had a significantly longer time until the start of oral intake and a significantly lower median value of Food Intake Level Scale at the time of discharge. According to univariate and multivariate analyses, MWST score was a significant factor for predicting the onset of pneumonia even after adjusting for patient characteristics and surgical factors, and the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less.

The MWST score after extubation in cardiovascular surgery was the strongest predictor of postoperative pneumonia in BSEs. Furthermore, the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less. Predicting cases with a high risk of developing pneumonia allows nurses and attending physicians to monitor the progress carefully and take aggressive preventive measures.
Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis
Authors: Ou Wei-Fan , Huang Wei-Hsuan , Chiu Hsien-Fu , Mao Yan-Chiao , Wen Mei-Chin , Chen Cheng-Hsu , Hung Sheng-Jou , Wu Ming-Ju , Wu Chieh-Liang , Chao Wen-Cheng
Published: January 2021

Introduction:

Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings.

Patient concerns:

Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis).

Diagnosis:

Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings.

Interventions:

Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17.

Outcomes:

Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2.

Conclusion:

In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
Effects of acupuncture on postoperative recovery and extubation time
Authors: Kwon Seungwon , Jin Chul , Jeong Aram , Yang Seung-Bo
Published: January 2021

Background:

This systematic review protocol aims to provide evidence of the efficacy and safety of acupuncture on postoperative recovery and extubation time.

Methods:

The following 11 electronic databases will be searched from inception: The Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, AMED, CINAHL, 1 Chinese database (CNKI), and 5 Korean databases (OASIS, DBpia, RISS, KISS, NDSL). Only randomized controlled trials of acupuncture treatment for postoperative recovery after surgery will be included for review. The selection of the studies, data extraction, and management will be performed independently by 3 researchers. Methodological quality, including the risk of bias, will be assessed using the Cochrane risk of bias assessment tool.

Results and Conclusions:

Our systematic review will provide evidence of the efficacy of acupuncture on postoperative recovery and extubation time. This evidence will provide useful information to practitioners and patients in the field of surgery and complementary medicine.

PROSPERO registration number:

2020 CRD42020168411
Predicting 72-h mortality in patients with extremely high random plasma glucose levels
Authors: Watanabe Tamami , Sugawara Hitoshi , Saito Kai , Ishii Akira , Fukuchi Takahiko , Omoto Kiyoka
Published: January 2021

The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear.

To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions.

Retrospective, single-center, case-controlled cross-sectional study.

University teaching hospital.

Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013.

Extremely high RPG (≥500 mg/dl).

Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity.

A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (−5.142 + 0.901log (CK) −1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%.

The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.
Prognostic significance of ANO1 expression in cancers
Authors: Zhang Congxiao , Li Haini , Gao Jing , Cui Xiaoqing , Yang Shengmei , Liu Zongtao
Published: January 2021

Background:

Anoctamin-1 (ANO1) plays a pivotal role in cancer progression. A meta-analysis was conducted to assess the potential prognostic role of ANO1 in cancers.

Methods:

A total of 1760 patients from 7 eligible studies were included into the analysis. Pooled hazard ratios or odds ratios were extracted and calculated with a random-effects model, and analyses of heterogeneity bias were conducted.

Results:

Our results showed that over expression of ANO1 was significantly correlated with poor overall survival in all cancers (HR = 1.52; 95% CI: 1.19–1.92; P = .0006). Subgroup analysis indicated that there was a significant association between over expression of ANO1 and poor prognosis breast cancer (HR = 3.24; 95% CI: 1.74–6.04), head and neck squamous cell carcinoma (HR = 1.14; 95% CI: 1.00–1.30), esophageal squamous cell carcinoma (HR = 1.93; 95% CI: 1.07–3.50), gastric cancer (HR = 1.62; 95% CI: 1.12–2.34) and colorectal cancer (HR = 1.38; 95% CI: 1.03–1.85). In addition, over expression of ANO1 was not associated with TNM stage, histological grade, lymph node metastasis, tumor size, age and gender. However, ANO1 was significantly associated with human epidermal growth factor receptor 2, but not associated with progesterone receptor or estrogen receptor in breast cancer.

Conclusions:

Our results indicate that ANO1 can be a predictive factor for prognosis of cancer.
Enoxaparin Dose Requirements to Achieve Therapeutic Low–molecular-weight Heparin Anti-factor Xa Levels in Infants and Young Children
Authors: Wysocki Emma L. , Kuhn Alexis , Steinbrenner Jenny , Tyrrell Laura , Abdel-Rasoul Mahmoud , Dunn Amy , Cloyd Colleen
Published: January 2021

Introduction:

Enoxaparin is commonly used to treat pediatric thrombosis. Several small retrospective studies have suggested that infants and young children require higher enoxaparin doses to achieve therapeutic anti-factor Xa levels compared with adults.

Materials and Methods:

This is a retrospective study of hospitalized children who received enoxaparin for the treatment of thrombosis at a free-standing children’s hospital. The primary objective was to ascertain the enoxaparin dose required to achieve an anti-factor Xa level of 0.5 to 1.0 U/mL among 4 age groups in a large cohort of infants and young children between 60 days and 5 years of age.

Results:

A total of 176 infants and children were evaluated. The majority of patients were less than 1 year of age (n=104). An inverse relationship between enoxaparin dose needed to achieve therapeutic anti-factor Xa levels and patient age was noted, particularly in the first year of life. Patients who were 60 days to less than 7 months at the time of enoxaparin initiation (n=73) required the highest mean dose among the age groups at 1.73 mg/kg subcutaneously every 12 hours (P<0.0001).

Conclusion:

Infants and young children require higher doses of enoxaparin to achieve therapeutic anti-factor Xa levels compared with adults.
Elevated Red Cell Distribution Width as a Useful Marker in Neonatal Sepsis
Authors: Bulut Ozgul , Akcakaya Aysimin , Bulut Nurgul , Ovali Fahri
Published: January 2021

Neonatal sepsis is an important cause of neonatal morbidity and mortality in the neonatal intensive care unit. Red blood cell distribution width (RDW) is an important and independent prognostic factor in several diseases. The objective of this study was to evaluate the diagnostic value of RDW in neonatal sepsis. An observational, retrospective cohort study was conducted on newborns admitted to the neonatal intensive care unit in a Tertiary Care University Hospital between 2016 and 2019. Patients were classified into sepsis and control groups. Demographic characteristics and laboratory findings including RDW were analyzed. RDW was significantly higher in the sepsis group than in the control group (P=0.001). RDW had an area under the receiver operating characteristic curve of 0.799 for the diagnosis of sepsis. The sensitivity and specificity of an RDW value of 17.4% were found to be 60% and 88.3%, respectively (P=0.001). Multivariable logistic regression analysis showed a positive association of RDW with sepsis (odds ratio: 2.71; 95% confidence interval: 2.19-3.36; P=0.001). RDW value was significantly higher in neonatal sepsis and could be used as a useful alternative to other assessment tools as a readily available biomarker.
Deep Vein Thrombosis After a Wild Bee Sting
Authors: Cil Metin , Leblebisatan Goksel , Leblebisatan Serife , Barutcu Adnan , Cil Merve K. , Kilinc Yurdanur
Published: January 2021

Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.
Glypican-1, -3, -5 (GPC1, GPC3, GPC5) and Hedgehog Pathway Expression in Oral Squamous Cell Carcinoma
Authors: Schlaepfer Sales Caroline B. , Guimarães Vanessa S.N. , Valverde Ludmila F. , Dias Rosane B. , Freitas Raíza D. , Siquara da Rocha Leonardo de Oliveira , Coelho de Miranda Malu , Vilas Bôas Deise S. , Gonçalves Agra Ivan M. , dos Santos Jean N. , Gurgel Rocha Clarissa A.
Published: January 2021

Proteoglycans are involved in tumor development and may regulate the Hedgehog (HH) pathway. This study aimed to investigate the gene and protein expression of glypican-1 (GPC1), -3 (GPC3), and -5 (GPC5) in oral squamous cell carcinoma (OSCC) and tumor-free lateral margins (TM) and their association with the HH pathway. Quantitative PCR was performed for GPC1, GPC3, GPC5, SHH, PTCH1, SMO, and GLI1 genes in samples of OSCC (n=31), TM (n=12), and non-neoplastic oral mucosa (NNM) of healthy patients (n=6), alongside an immunohistochemical evaluation of GPC1, GPC3, and GPC5 proteins and HH proteins SHH and glioma-associated oncogene homolog 1 (GLI1). Double staining for GPC3/SHH, GPC5/SHH, GPC3/tubulin [ac Lys40], GPC5/Tubulin [ac Lys40], and GPC5/GLI1 was also performed. Overexpression of GPC1 and GPC5 in tumor samples and underexpressed levels of GPC3 gene transcripts were observed when compared with TM (standard sample). HH pathway mRNA aberrant expression in OSCC samples and a negative correlation between GPC1 and GPC5 at transcription levels were detected. GPC1 staining was rare in OSCC, but positive cells were found in NNM and TM. Otherwise positive immunostaining for GPC3 and GPC5 was observed in OSCCs, but not in NNM and TM. Blood vessels adjacent to tumor islands were positive for GPC1 and GPC5. Co-localization of GPC3-positive and GPC5-positive cells with SHH and Tubulin [ac Lys40] proteins was noted, as well as of GPC5 and GLI1. The absence of the GPC1 protein in neoplastic cells, underexpression of the GPC3 gene, and co-localization of GPCs and HH proteins may indicate the maintenance of aberrant HH pathway activation in OSCC.
Stratification of Bleeding Risk Using Thromboelastography in Children on Extracorporeal Membrane Oxygenation Support*
Authors: Sleeper Lynn A. , Mulone Michelle , Diallo Fatoumata , Nasr Viviane G. , Thiagarajan Ravi R. , Emani Sitaram , Emani Sirisha
Published: January 2021

Objectives:

Patients undergoing extracorporeal membrane oxygenation are at high risk for bleeding and thrombotic complications. Current laboratory methods for assessing the coagulation system may be imprecise and complicate clinical decision-making. We hypothesize that thromboelastography may be more strongly associated with bleeding events than traditional methods and can aid extracorporeal membrane oxygenation coagulation management.

Design:

In a retrospective study, 40 patients with congenital heart disease requiring extracorporeal membrane oxygenation support yielded a total of 159 patient days of data for thromboelastography analysis.

Setting:

Pediatric cardiac ICU at a single institution.

Subjects:

Pediatric patients (≤ 18 yr) with congenital heart disease requiring extracorporeal membrane oxygenation support.

Interventions:

None.

Methods:

Thromboelastography was performed on whole blood samples collected 6–12 hours following extracorporeal membrane oxygenation initiation and daily for the duration of extracorporeal membrane oxygenation. Bleeding during each 24-hour period was defined as need for re-exploration or need for blood transfusion. Associations between thromboelastography variables and bleeding over each 24-hour period (bleeding vs nonbleeding days) were assessed using mixed effects logistic regression and classification and regression tree analysis.

Measurements and main results:

Bleeding occurred in 25 patients (63%), contributing 87 bleeding days (55% extracorporeal membrane oxygenation days) for analysis. The probability of bleeding within the 24-hour period was not associated with activated partial thromboplastin time (p = 0.6) or anti-Xa levels (p = 0.3) on that day. The strongest correlate of bleeding was a maximum amplitude less than 55.4 mm on thromboelastography (odds ratio, 3.28; 95% CI, 1.63–6.60; p < 0.001). Bleeding occurred on 73% versus 35% of extracorporeal membrane oxygenation days for maximum amplitude less than 55.4 mm versus greater than or equal to 55.4 mm, respectively. Bleeding occurred on all days when a combination of maximum amplitude less than 55.4 mm and a reaction time greater than 12.9 minutes was present. The lowest risk of bleeding (28% of patient days) was associated with maximum amplitude greater than or equal to 55.4 mm and plasma fibrinogen greater than 345 mg/dL.

Conclusions:

Thromboelastography-derived variables maximum amplitude and reaction time, along with plasma fibrinogen levels, can help predict bleeding events in children on extracorporeal membrane oxygenation support. Research based on larger patient samples is needed to confirm the specific thresholds identified for bleeding risk stratification for extracorporeal membrane oxygenation anticoagulation management.
Diagnostic Value of Monocyte-to-Lymphocyte Ratio Against Other Biomarkers in Children With Appendicitis
Authors: Duman Levent , Karaibrahimoğlu Adnan , Büyükyavuz Behçet İlker , Savaş Mustafa Çağri
Published: January 2021

Objectives

This study aimed to investigate diagnostic value of monocyte-to-lymphocyte ratio as a novel biomarker in children with appendicitis and to compare with other biomarkers.

Methods

A total of 683 children were included in this retrospective study. Patients were categorized as acute appendicitis (AA, n = 254), perforated appendicitis (PA, n = 82), nonspecific abdominal pain (NAP, n = 197), and control (n = 150). The groups were compared for demographics, duration of symptoms, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), white blood cell count, neutrophil percentage (NP), C-reactive protein (CRP), mean platelet volume, and sodium level.

Results

There was a significant difference between all groups for MLR, PLR, and CRP. White blood cell count, NP, and NLR were significantly increased in patients with appendicitis, but there was no significant difference in the differential diagnosis between PA and AA. Sodium levels significantly decreased in patients with appendicitis. No statistically significance was determined between all groups in term of mean platelet volume. Among the biomarkers, MLR showed the highest diagnostic value (area under the receiver operator characteristic curve = 0.798) for AA, while CRP showed excellent diagnostic value (area under the receiver operator characteristic curve = 0.897) for PA.

Conclusions

To our knowledge, this is the first study showing that MLR is a valuable parameter to differentiate patients with and without appendicitis. White blood cell, NP, and NLR are also useful parameters. On the other hand, an increased CRP level and hyponatremia are indicators of PA.
Pediatric Train Injuries
Authors: Pennell Christopher , Lindholm Erika , Latreille Jacob , Kadakia Shreeja , Nanassy Autumn , Ciullo Sean , Arthur L. Grier , Grewal Harsh , Prasad Rajeev
Published: January 2021

Objectives

Trains can cause severe injuries in pediatric patients requiring significant resource utilization. We sought to review train injuries in Pennsylvania to determine the burden of these injuries on the pediatric trauma system.

Methods

We queried the Pennsylvania Trauma Outcomes Study Database to identify patients younger than 18 years injured by trains between 2007 and 2016. Demographics, hospital course, outcomes, and resource utilization were reviewed.

Results

Thirty-five children from 17 Pennsylvania counties were included. Three counties accounted for 48.6% of injured children. The median age was 15.0 years, and most patients were White (60.0%) and male (77.1%). The median length of stay was 8.0 days and overall mortality 8.6%. Intensive care unit admission was required for 65.7%. The median Injury Severity and Functional Status at Discharge scores were 14.0 and 18.0, respectively. Major orthopedic injuries (fracture or amputation) were the most common (57.1%) followed by traumatic brain injury (45.7%), pneumothorax (14.3%), and solid organ injury (14.3%). Operative management was common with 65.7% undergoing surgery.

Conclusions

Injuries caused by trains can be severe and are most commonly orthopedic or traumatic brain injuries. Targeted safety interventions may be possible given the common mechanisms and geographic clustering of these injuries.
Occult Bone Metastases From Hepatocellular Carcinoma Detected on 68Ga-PMSA PET/CT
Authors: Usmani Sharjeel , Rasheed Rashid , Al Kandari Fareeda , Ahmed Najeeb
Published: January 2021

68Ga-PSMA is an excellent radiotracer for both staging and detection of recurrence in prostate cancer, but it can also be useful in other solid tumors due to tumor-associated angiogenic factors and endothelial cell sprouting. We report a case of an 82-year-old man with hepatocellular carcinoma who presented with rising tumor marker but stable CT findings 6 months after transarterial chemoembolization. 68Ga-PSMA PET/CT showed high PSMA-expressing hyperneovascular hepatic lesions (primary tumor), additional multifocal hepatic lesions, and with unexpected multiple bone metastases. 68Ga-PSMA expression in hepatocellular carcinoma can influence patient management and potentially guide radionuclide legend therapy.
18F-FDG PET/CT Monitoring of Response to Programmed Death Protein 1 Blockade in Metastatic Basal Cell Carcinoma
Authors: Jadvar Hossein , In Gino K.
Published: January 2021

A 73-year-old woman with history of metastatic basal cell carcinoma presented with a large spinal mass demonstrating a high mutational burden of 111 mutations/Mb. She underwent T12 corpectomy and T10–L3 posterior spinal fusion followed by adjuvant radiation. After 2 years of surveillance, FDG PET/CT and a contrast-enhanced MRI revealed recurrence, prompting salvage therapy with the hedgehog signaling pathway inhibitor, sonidegib, which only transiently stabilized the disease. An off-label treatment with the programmed death protein 1 inhibitor, pembrolizumab, was initiated. Serial FDG PET/CT showed gradual decline in tumor metabolism over the next 12 months, leading to complete metabolic response.
Narrative Discourse Intervention After Traumatic Brain Injury
Authors: Steel Joanne , Elbourn Elise , Togher Leanne
Published: January 2021

Purpose:

Narrative discourse (e.g., telling anecdotes or relating personal events) comprises a key part of social interaction and is commonly affected after traumatic brain injury (TBI). Research over the past decades has enabled improved characterization of discourse impairment after TBI, but a critical lack of research into discourse intervention approaches remains.

Methods:

This systematic review examined empirical research on narrative discourse intervention after TBI. Searches were conducted on EMBASE, CINAHL, PsycINFO, and PubMed for original research on spoken narrative discourse treatment, where at least 50% of the study participants were adults with TBI.

Results:

Of 519 screened articles, six studies met criteria: three single case studies and three case series studies. Interventions incorporated metacognitive and metalinguistic theoretic principles, with a focus on understanding the structure and elements of narratives. Active components of treatments are discussed and compared in relation to existing narrative discourse treatment programs for other neurological communication disorders.

Conclusions:

Although all studies reported gains on some measures for treated narratives following intervention, there were mixed results for effect generalization and/or maintenance. The INCOG guidelines recommend that interventions after TBI should be contextualized and involve personally relevant materials, and this was not evident in the reviewed intervention approaches. Directions are suggested for clinical practice and future research in treating narratives.
Measuring Change at the Discourse-Level Following Conversation Treatment
Authors: DeDe Gayle , Hoover Elizabeth
Published: January 2021

Purpose:

This article reviews four discourse measures and examines whether they are sensitive to impairments in people with both mild and severe aphasia. We also ask whether these measures were sensitive to effects of conversation treatment in two case examples.

Method:

Two people with aphasia, one mild and fluent and the other severe and nonfluent, served as case studies. Both case studies had participated in conversation treatment, in which individualized goals were targeted in the context of naturalistic conversation-based interactions. Picture descriptions were analyzed using three discourse measures: core lexicon, words per minute, and correct information units. In addition, words per minute and conversation turns were examined in personal narratives produced by the individual with severe nonfluent aphasia in a conversational context.

Results:

For the individual with mild aphasia, both words per minute and core lexicon were sensitive to the presence of aphasia and treatment changes. For the individual with severe aphasia, all measures were sensitive to the presence of aphasia, but only words per minute and number/type of conversation turns were sensitive to effects of treatment.

Discussion/Conclusions:

Discourse measures capture relevant aspects of communication that may not be seen on standardized measures of discrete language skills. Given different aphasia profiles and individual communication goals, clinicians need to choose the most relevant, reliable, and informative measures.
Making Sense of Right Hemisphere Discourse Using RHDBank
Authors: Minga Jamila , Johnson Melissa , Blake Margaret Lehman , Fromm Davida , MacWhinney Brian
Published: January 2021

Purpose:

Right hemisphere brain damage (RHD) commonly causes pragmatic language disorders that are apparent in discourse production. Specific characteristics and approaches to assessment, diagnosis, and treatment of these disorders are not well-defined. RHDBank, a shared database of multimedia interactions for the study of communication using discourse, was created to address these gaps. The database, materials, and related analysis programs are free resources to clinicians, researchers, educators, and students.

Method:

A standard discourse protocol was developed to elicit multiple types of discourse: free speech, conversation, picture description, storytelling, procedural discourse, and question-asking. Testing included measures of cognition, unilateral neglect, and communicative participation. Language samples were video-recorded and transcribed in CHAT format. Currently, the database includes 24 adults with RHD and 24 controls.

Results:

Illustrative analyses show how RHDBank can facilitate research using micro- and macrolinguistic discourse analysis techniques both within this population and across populations. Educational resources, such as the Grand Rounds tutorial, were developed using case studies from the database.

Conclusions:

RHDBank is a shared database of resources that can facilitate educational and research efforts to address the gaps in knowledge about RHD communication and improve the clinical management of individuals with RHD.
Obesity and Oxidative Stress in Older Adults At Risk for Dementia
Authors: Turner Ashlee , Hoyos Camilla , Mowszowski Loren , LaMonica Haley , Lagopoulos Jim , DeMayo Marilena M. , Ireland Catriona , Hickie Ian B. , Naismith Sharon L. , Duffy Shantel L.
Published: January 2021

Objective:

This study aimed to investigate the relationship between obesity and oxidative stress in older adults at risk for dementia. It also aimed to explore the influence of physical activity on the relationship between obesity and oxidative stress in this at risk cohort.

Methods:

Older adults at risk for dementia underwent comprehensive medical, neuropsychological, and psychiatric assessment. At risk was defined as participants with subjective or mild cognitive impairment. Glutathione was assessed by magnetic resonance spectroscopy in the left hippocampus and the anterior and posterior cingulate cortex. Body mass index (BMI) was calculated and classified as healthy (BMI <25 kg/m2) or overweight/obese (BMI ≥25 kg/m2).

Results:

Sixty-five older adults (mean age=66.2 y) were included for analysis. The overweight/obese group had significantly greater glutathione in the hippocampus compared with the healthy weight group (t=−2.76, P=0.008). No significant difference in glutathione was observed between groups in the anterior or posterior cingulate. In the overweight/obese group, a higher BMI was associated with a diabetes diagnosis and lower total time engaging in physical activity (r=−0.36, P=0.025), however, glutathione did not correlate with activity levels across groups.

Conclusion:

This study demonstrates that changes in in vivo markers of oxidative stress are present in overweight/obese older adults at risk for dementia. Future research should explore the relationship with diabetes and the longitudinal relationship between BMI and oxidative stress, and response to therapeutic interventions.
Cardiometabolic medicine: a review of the current proposed approaches to revamped training in the United States
Authors: Soroosh Garshasb P. , Dzaye Omar , Reiter-Brennan Cara , Blaha Michael J.
Published: January 2021

Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, and the population of patients with cardiometabolic conditions, including obesity, metabolic syndrome and diabetes mellitus, continues to grow. There is a need for physicians with specific training in cardiometabolic medicine to provide a ‘medical home’ for patients with cardiometabolic disease, rather than the fractured care that currently exists in the United States. Cardiometabolic specialists will head multidisciplinary clinics, develop practice guidelines, and lead through research. Proposals for US training in cardiometabolic medicine include: maintain the current training model, a dedicated 2–3 year fellowship following internal medicine residency, a 1-year fellowship following either internal medicine residency or fellowship in cardiology or endocrinology, and certification available to any interested clinician. This review discusses the pros and cons of these approaches. The authors believe that a dedicated cardiometabolic training fellowship has significant advantages over the other options.
Seq-Scope: Submicrometer-resolution spatial transcriptomics for single cell and subcellular studies
Authors: Cho Chun-Seok , Xi Jingyue , Park Sung-Rye , Hsu Jer-En , Kim Myungjin , Jun Goo , Kang Hyun-Min , Lee Jun Hee
Published: January 2021

Spatial barcoding technologies have the potential to reveal histological details of transcriptomic profiles; however, they are currently limited by their low resolution. Here we report Seq-Scope, a spatial barcoding technology with a resolution almost comparable to an optical microscope. Seq-Scope is based on a solid-phase amplification of randomly barcoded single-molecule oligonucleotides using an Illumina sequencing-by-synthesis platform. The resulting clusters annotated with spatial coordinates are processed to expose RNA-capture moiety. These RNA-capturing barcoded clusters define the pixels of Seq-Scope that are approximately 0.5-1 μm apart from each other. From tissue sections, Seq-Scope visualizes spatial transcriptome heterogeneity at multiple histological scales, including tissue zonation according to the portal-central (liver), crypt-surface (colon) and inflammation-fibrosis (injured liver) axes, cellular components including single cell types and subtypes, and subcellular architectures of nucleus, cytoplasm and mitochondria. Seq-scope is quick, straightforward and easy-to-implement, and makes spatial single cell analysis accessible to a wide group of biomedical researchers.