bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Dynamics of Host Immune Response Associated With Disease Severity and Time to Recovery in Patients Hospitalized for COVID-19
Authors: Sophonsri Anthony , Le Diana , Lou Mimi , Ny Pamela , Minejima Emi , Chambliss Allison B. , Nieberg Paul , Shriner Kimberly , Wong-Beringer Annie
Published: September 2022

OBJECTIVES:

The objective of this study was to compare the temporal dynamics of two viral-induced inflammatory proteins interferon gamma inducible protein-10 (IP-10) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), as well as C-reactive protein (CRP) among patients hospitalized for COVID-19 and examine their prognostic significance.

DESIGN:

Prospective observational cohort study.

SETTING:

Multicenter, inpatient.

PATIENTS:

Adult patients infected with severe acute respiratory syndrome coronavirus 2 between March 2021 and October 2021.

INTERVENTIONS:

Patient sera were collected on days 1, 3, 5, and 7 of hospitalization. Levels of IP-10, TRAIL, and CRP were measured using a point-of-need diagnostic immunoassay platform (MeMed BV, MeMed, Haifa, Israel) and compared between patients grouped by disease severity (severe vs nonsevere).

MEASUREMENTS AND MAIN RESULTS:

Baseline characteristics were similar regardless of severity except for a higher prevalence of diabetes and heart failure among severe patients. The immune profile at admission was similar between groups; IP-10 and CRP levels generally decreased while TRAIL levels increased over time in all patients. However, the severe group had higher IP-10 (median 713 vs 328 pg/mL; p = 0.045) and lower TRAIL levels (median 21 vs 30 pg/mL; p = 0.003) on day 3 compared with nonsevere patients. A breakpoint IP-10 level of greater than or equal to 570 pg/mL and TRAIL level of less than 25 pg/mL on day 3 were associated with COVID-19 severity. Patients with elevated day 3 IP-10 levels (≥ 570 pg/mL) were more likely to experience prolonged recovery time (median 12 vs 3 d; p < 0.001). The severe group had prolonged use of corticosteroids (12 vs 5 d; p < 0.001) and had a higher rate of secondary infections (20% vs 6%; p = 0.04) and in-hospital mortality (20% vs 0%; p < 0.001) as compared with nonsevere patients.

CONCLUSIONS:

The observed patterns in host immune response revealed a turning point in COVID-19 disease on hospital day 3 and the potential utility of IP-10 and TRAIL as sensitive markers associated with disease severity and time to recovery.
Selecting lymph node–positive patients for adjuvant therapy after radical prostatectomy and extended pelvic lymphadenectomy: An outcome analysis of 100 node-positive patients managed without adjuvant therapy
Authors: Tamhankar Ashwin Sunil , Patil Saurabh , Singh Shanky , Carbin Danny Darlington , Mokal Smruti , Ahluwalia Puneet , Gautam Gagan
Published: September 2022

Objective

The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence (BCR) and other survival parameters in node-positive prostate cancer patients after robot-assisted radical prostatectomy with bilateral extended pelvic lymph node dissection (RARP + EPLND).

Materials and methods

Of the 453 consecutive RARP procedures performed from 2011 to 2018, 100 patients with no prior use of androgen deprivation therapy were found to be lymph node (LN) positive and were observed, with initiation of salvage treatment at the time of BCR only. Patients were divided into 1 or 2 LNs (67)—and more than 2 LNs (33)—positive groups to assess survival outcomes.

Results

At a median follow-up of 21 months (1–70 months), the LN group (p < 0.000), preoperative prostate-specific antigen (PSA, p = 0.013), tumor volume (TV, p = 0.031), and LND (p = 0.004) were significantly associated with BCR. In multivariate analysis, only the LN group (p = 0.035) and PSA level (p = 0.026) were statistically significant. The estimated BCR-free survival rates in the one-half LN group were 37.6% (27%–52.2%), 26.5% (16.8%–41.7%), and 19.9% (9.6%–41.0%) at 1, 3, and 5 years, respectively, with a hazard of developing BCR of 0.462 (0.225–0.948) compared with the more than 2 LN-positive group. Estimated 5-year overall survival, cancer-specific, metastasis-free, and local recurrence–free survival rates were 88.4% (73.1%–100%), 89.5% (74%–100%), 65.1% (46.0%–92.1%), and 94.8% (87.2%–100.0%), respectively, for which none of the factors were significant. Based on cutoff values for PSA, TV, and LND of 30 ng/mL, 30%, and 10%, respectively, the 1/2 LN group was substratified, wherein the median BCR-free survival for the low- and intermediate-risk groups was 40 and 12 months, respectively.

Conclusions

Nearly one fourth and one fifth of one-half node-positive patients were BCR-free at 3 and 5 years after RARP + EPLND. Further substratification using PSA, TV, and LN density may help in providing individualized care regarding the initiation of adjuvant therapy.
Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database
Authors: Singh Partik , Smith Franki Lambert , Brown Marc D.
Published: September 2022

BACKGROUND

Use of Mohs micrographic surgery (MMS) is highly prevalent, but little data are available on how surgeon experience affects surgical practice patterns.

OBJECTIVE

To determine differences in use of MMS among surgeons of varying experience.

MATERIALS AND METHODS

This cross-sectional study sampled from clinicians billing ≥200 mean annual Mohs surgery claims from the 2012 to 2018 Medicare Public Use File. The primary outcome was mean annual Mohs surgery claims for clinicians of varying experience. Secondary outcomes included use of flaps/grafts and prescribing of oral antibiotics, benzodiazepines, and opioids.

RESULTS

Among 1,759 unique surgeons, those with 16 to 20 years of experience performed the most mean annual (95% confidence interval) Mohs surgical cases (578.7 [556.7–600.6]). Surgeons with 21 to 25 years of experience prescribed the most antibiotics (240.2 [216.5–263.8] mean annual claims), whereas those with >35 years of experience prescribed the longest courses (15.3 [14.2–16.4] days).

CONCLUSION

Midcareer surgeons performed the most mean annual Mohs surgery cases, whereas later career surgeons prescribed more frequent and longer courses of antibiotics suggesting changing practice patterns with additional years of experience.
The effects of curcumin in learning and memory impairment associated with hypothyroidism in juvenile rats: the role of nitric oxide, oxidative stress, and brain-derived neurotrophic factor
Authors: Ahmadabady Somaieh , Hosseini Mahmoud , Shafei Mohammad Naser , Marefati Narges , Salmani Hossein , Amirahmadi Sabiheh , Mortazavi Sani Sakineh Sadat , Beheshti Farimah
Published: September 2022

The effect of curcumin (Cur) on cognitive impairment and the possible role of brain tissue oxidative stress, nitric oxide (NO) levels, and brain-derived neurotrophic factor (BDNF) were investigated in juvenile hypothyroid rats. The juvenile rats (21 days old) were allocated into the following groups: (1) control; (2) hypothyroid (0.05% propylthiouracil (PTU) in drinking water); (3–5) hypothyroid-Cur 50, 100, and 150, which in these groups 50, 100, or 150 mg/kg, Cur was orally administered by gavage during 6 weeks. In the hypothyroid rats, the time elapsed and the traveled distance to locate the hidden platform in the learning trials of Morris water maze (MWM) increased, and on the probe day, the amount of time spent in the target quadrant and the distance traveled in there was decreased. Hypothyroidism also decreased the latency and increased the time spent in the darkroom of the passive avoidance (PA) test. Compared with the hypothyroid group, Cur enhanced the performance of the rats in both MWM and PA tests. In addition, Cur reduced malondialdehyde concentration and NO metabolites; however, it increased thiol content as well as the activity of catalase (CAT) and superoxide dismutase enzymes in both the cortex and hippocampus. Cur also increased hippocampal synthesis of BDNF in hypothyroid rats. The beneficial effects of Cur cognitive function in juvenile hypothyroid rats might be attributed to its protective effect against oxidative stress and potentiation of BDNF production.
Personalized external aortic root support in aneurysm disease
Authors: Treasure Tom , Austin Conal , Kenny Louise Amelia , Pepper John
Published: September 2022

Purpose of review

To bring together and annotate publications about personalised external aortic reported in the 18 months preceding submission.

Recent findings

The total number of personalised external aortic root support (PEARS) operations is now approaching 700 in 32 centres in Australia, Belgium, Brazil, Czech Republic, Great Britain, Greece, Ireland, Malaysia, Netherlands, New Zealand, Poland and Slovakia. There are continued reports of stability of aortic dimensions and aortic valve function with the only exceptions known being where the surgeon has deviated from the directions for use of the device. The median root diameter of Marfan patients having PEARS was 47 mm suggesting that the existing criterion of 50 mm is due for reconsideration. The peri-operative mortality in the first 200 patients was 0.5% and is currently estimated to be less than 0.2%. The first recipient remains alive and well after 18 years. The use of PEARS as an adjunct to the Ross operation to support the pulmonary autograft is being explored in several centres.

The operation requires proctoring and adherence to a strict operative protocol and with those precautions excellent results are attained. The evidence and opinions provided in these publications indicate that this is proven and successful prophylactic operation for aortic root aneurysm.
It's not all about ISCHEMIA: the case for coronary artery bypass grafting in stable coronary artery disease
Authors: Yan Weiang , Eikelboom Rachel , Muller Moran Hellmuth R. , Arora Rakesh C.
Published: September 2022

Purpose of Review

The recent American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions Guidelines for Coronary Artery Revascularization have raised concerns on the survival benefits of coronary artery bypass grafting (CABG) over guideline-directed medical therapy (GDMT) in stable coronary artery disease (CAD) and appropriate conduit selection for CABG. This review summarizes the evidence supporting CABG for stable CAD and use of the radial artery as a conduit for CABG.

Recent Findings

CABG has consistently demonstrated a survival benefit over GDMT for patients with stable multivessel CAD. These benefits were more pronounced in patients with diabetes and/or anatomically complex coronary artery disease. The recently published International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial was not designed to and did not include an appropriate patient population to compare revascularization with CABG to GDMT. These results should thus be viewed in the context of previously published studies. Furthermore, increasing evidence suggests that use of a radial artery in CABG is associated with reduced myocardial infarction and repeat revascularization. This should be considered when selecting the appropriate conduits based on underlying patient factors.

Readers should be cautious when applying these guidelines broadly. Appropriate consideration of patient and anatomic factors, and in consultation with a multidisciplinary heart team, is important to achieve the best outcomes for patients.
Outcomes of Patients With Thyroid Eye Disease Partially Treated With Teprotumumab
Authors: Ho Tiffany C. , Maamari Robi N. , Kossler Andrea L. , Sears Connie M. , Freitag Suzanne K. , Reshef Edith R. , Shinder Roman , Rootman Daniel B. , Diniz Stefania B. , Kahana Alon , Schlachter Dianne , Do Thai H. , Kally Peter , Turner Sara , Mokhtarzadeh Ali , Harrison Andrew R. , Hwang Christopher J. , Kim Hee Joon , Avila Sarah A. , Thomas Dilip A. , Magazin Maja , Wester Sara T. , Lee Wendy W. , Clauss Kevin D. , Holds John B. , Sniegowski Matthew , Compton Christopher J. , Briggs Christian , Malik Amina I. , Lucarelli Mark J. , Burkat Cat N. , Patel Luv G. , Couch Steven M.
Published: September 2022

Purpose:

In response to the coronavirus (COVID-19) pandemic, teprotumumab production was temporarily halted with resources diverted toward vaccine production. Many patients who initiated treatment with teprotumumab for thyroid eye disease were forced to deviate from the standard protocol. This study investigates the response of teprotumumab when patients receive fewer than the standard 8-dose regimen.

Methods:

This observational cross-sectional cohort study included patients from 15 institutions with active or minimal to no clinical activity thyroid eye disease treated with the standard teprotumumab infusion protocol. Patients were included if they had completed at least 1 teprotumumab infusion and had not yet completed all 8 planned infusions. Data were collected before teprotumumab initiation, within 3 weeks of last dose before interruption, and at the visit before teprotumumab reinitiation. The primary outcome measure was reduction in proptosis more than 2 mm. Secondary outcome measures included change in clinical activity score (CAS), extraocular motility restriction, margin reflex distance-1 (MRD1), and reported adverse events.

Results:

The study included 74 patients. Mean age was 57.8 years, and 77% were female. There were 62 active and 12 minimal to no clinical activity patients. Patients completed an average of 4.2 teprotumumab infusions before interruption. A significant mean reduction in proptosis (–2.9 mm in active and –2.8 mm in minimal to no clinical activity patients, P < 0.01) was noted and maintained during interruption. For active patients, a 3.4-point reduction in CAS (P < 0.01) and reduction in ocular motility restriction (P < 0.01) were maintained during interruption.

Conclusions:

Patients partially treated with teprotumumab achieve significant reduction in proptosis, CAS, and extraocular muscle restriction and maintain these improvements through the period of interruption.
Association of Monocyte-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios With Persistent Critical Illness in Patients With Severe Trauma
Authors: Zhang Beiyuan , Han Yunhong , Chen Xiancheng , Cao Ke , You Yong , Chen Ming , Zhu Zhanghua , Yu Wenkui
Published: September 2022

BACKGROUND:

Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are reported to reflect the inflammation and immune status in critically ill patients, but their role in severe trauma patients with persistent critical illness remains to be elucidated.

OBJECTIVE:

We aimed to evaluate the relationship of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio with persistent critical illness in severe trauma patients.

METHODS:

In a single-center retrospective cohort study, persistent critical illness was defined as intensive care unit length of stay of more than 10 days. Monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were computed individually and categorized into 3 tertiles. Logistic regression analysis was used to assess the relationship of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with persistent critical illness. Receiver operating characteristic curves and the Youden index were used to evaluate the discriminatory threshold of persistent critical illness.

RESULTS:

A total of 851 eligible patients were enrolled in the study: 328 patients with persistent critical illness and 523 without. The median levels of maximum neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio during intensive care unit stay were all higher in patients with persistent critical illness than in those without (11.46 vs. 9.13, p < .001 and 0.62 vs. 0.46, p < .001). Multivariate analysis revealed that the second (≥0.385, <0.693) and third (≥0.693) maximum monocyte-to-lymphocyte ratio tertiles were significantly associated with persistent critical illness after adjusting for confounding factors (odds ratio: 1.89, 95% confidence interval: 1.10–3.26, p = .021 and odds ratio 2.69, 95% confidence interval: 1.44–5.02, p = .002, respectively), whereas maximum neutrophil-to-lymphocyte ratio was not significantly correlated with persistent critical illness. The area under the curve for the maximum monocyte-to-lymphocyte ratio was 0.63 (95% confidence interval: 0.59–0.67), and the optimal cutoff was 0.65 for persistent critical illness.

CONCLUSION:

A high maximum monocyte-to-lymphocyte ratio during intensive care unit stay was independently related to persistent critical illness following severe trauma, although with limited sensitivity and specificity.
Trauma Resuscitation Room Organization Using 5S Methodology: A Quality Improvement Initiative
Authors: Philipose Jency , LaMaina Laura J. , Zapke Jennifer , Sargeant Danielle , Boukas Chris , Bullaro Francesca
Published: September 2022

BACKGROUND:

Trauma centers are required to have immediate availability of resources to stabilize traumatic injuries. However, maintaining trauma room organization can be challenging in the fast turnaround environment of trauma care. Implementation of 5S methodology has shown success in standardizing processes to maintain organized, efficient workspaces.

OBJECTIVE:

The purpose of this study was to assess the implementation of 5S methodology on trauma resuscitation room organization, efficiency, and cost-effectiveness.

METHODS:

This quality improvement pre- and postintervention study assessed the impact of 5S methodology on trauma resuscitation room organization. A 20-question survey was developed and administered to emergency department technicians before and after a multiphase intervention that included strategies for room reorganization, improved signage, creation of workstations, education, and implementation of a log sheet system. A final cost analysis was evaluated upon completion.

RESULTS:

Emergency department technicians completed n = 26 presurveys and n = 19 postsurveys. Room organization improved from preintervention 31% to postintervention 89%. Restocking with a checklist improved from 46% preintervention to 63% postintervention. A cost analysis summary identified 130 overstocked items equaling a total cost savings of $4,026.82.

CONCLUSION:

The 5S methodology improved trauma bay organization by sorting, organizing, standardizing, labeling, and color coding resuscitation supplies based on the ABCDE (airway, breathing, circulation, disability, and exposure) of the primary survey. Additional strategies included improved signage, workspace reorganization, staff education, and checklist restocking accountability. The 5S implementation resulted in significant cost savings.
Endobronchial Ultrasound-guided Sampling of Centrally Located Intrapulmonary Tumors Provides Suitable Material for Diagnostic and Molecular Testing
Authors: Rai Hem , Graham Emma , Ghoshal Avik , McDill Helen , Hassan Maged , Nicholson Thomas , Taylor Lindsey , Corcoran John , Howell Timothy , Daneshvar Cyrus
Published: September 2022

Background:

Curvilinear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic and staging procedure for patients with suspected lung cancer. However, sampling centrally located intrapulmonary tumors is feasible but less well established.

Methods:

We retrospectively evaluated the diagnostic utility of EBUS-TBNA in patients who underwent sampling of centrally located intrapulmonary tumors. Diagnostic accuracy, sample suitability for molecular testing, and complications were assessed.

Results:

Between January 2015 and April 2021, 102 EBUS-TBNA procedures sampled centrally located intrapulmonary tumors in 99 patients. The median age was 70 [interquartile range, 63 to 75] years and 51% (51/99) were male. The commonest site was the right upper lobe (n=42/99; 42%). The median tumor size was 29 [interquartile range, 21 to 35] mm. The diagnostic yield was 88/102 (86%) with a false negative rate of 14% (14/102). In addition to intrapulmonary tumor sampling, lymph nodes were sampled in 65/102 procedures and 30/65(46%) were positive for lung cancer. Cancer was diagnosed in 87/99 (88%) cases. When requested, molecular testing was adequate in ≥94% of samples. Complications included minor bleeding in 6/102 (6%) with 2 requiring cold saline instillation, desaturation in 1/102 (1%), and tachycardia in 1/102(1%). One procedure was abandoned due to patient tachycardia. Delayed complications occurred in 1 patient who was hospitalized ≤7 days with pneumonia.

Conclusion:

EBUS-TBNA sampling of centrally located intrapulmonary tumors provides similar diagnostic accuracy to lymph node sampling, provides suitable material for molecular testing, and has a low complication rate.
The relationship of left ventricular outflow tract presystolic wave and 24-h ambulatory blood pressure measurements
Authors: Demiröz Önder , Öztürkeri Burak
Published: September 2022

Objective

Left ventricular outflow tract (LVOT) presystolic wave is a novel marker for several cardiac conditions. It is shown to be related to several cardiac conditions. The aim of this study is to investigate the relationship between LVOT presystolic wave and 24-h ambulatory blood pressure measurements.

Methods

A total of 194 patients who came to the cardiology outpatient clinic were prospectively enrolled in the study. After demographic and clinical inquiry, blood biochemistry and hemogram tests were performed. Each patient was evaluated with echocardiography and 24-h ambulatory blood pressure measurement. The patients were divided into hypertensive and nonhypertensive groups regarding their ambulatory blood pressure measurements and the LVOT presystolic wave of the groups on echocardiography was compared.

Results

The hypertensive group was significantly older (59.34 ± 11.15 vs. 49.89 ± 15.43; P < 0.001). Presystolic wave presence (96.2 vs. 29.5%; P < 0.001) and velocity (62.23 vs. 29.42; P < 0.001) were higher in patients with hypertension. Blood pressure values and LVOT amplitudes showed a positive correlation (P < 0.001; r = 0.326). In multivariable logistic regression analysis; age, BMI and the presystolic wave were independently associated with hypertension (odds ratio: 8.09; P < 0.001).

Conclusion

LVOT presystolic wave is associated with systemic hypertension and it could be used as a predictor for systemic hypertensive patients.
Validation of Uright model TD 3127AT wireless-portable ambulatory blood pressure monitoring device with timer trigger modification, standard cuff size, in normotensive and mild hypertensive patients of Thailand registry (Thai valid ambulatory blood pressure monitoring)
Authors: Laosanguanek Wanchat , Kaewkanha Ponthakorn , Khowinthaseth Sirhavich , Sirisuth Sirawee , Phanthong Tanattida , Chokesuwattanaskul Ronpichai , Sangwatanaroj Somkiat
Published: September 2022

Background

Nowadays, automated blood pressure (BP) monitoring devices are commonly used by patients as a part of standard medical care for hypertension. The timer trigger was modified into a wireless automated home BP monitoring (HBPM) device to expand its potential use as ambulatory BP monitoring. However, the BP measurement accuracy in this modified device remains unknown.

Objective

We aimed to assess the accuracy of Uright model TD 3127AT, which is an automated HBPM device with a timer trigger modification, following an International Organization for Standardization (ISO) 81060-2:2018 guidelines in the Thai population.

Methods

This cross-sectional study included normotensive and hypertensive Thai participants following the ISO 81060-2:2018 guidelines from August 2021 to February 2022. This study aimed to compare the BP readings from an automated sphygmomanometer, Uright model TD 3127AT, TaiDoc Technology Corporation, with a timer trigger to a standard manual BP measurement.

Result

BPs were measured in 85 participants with a mean age ± SD of 38.39 ± 13.91 years, and 69% were females. The mean SBP ± SD (range) was 117.46 ± 18.63 (84–176) mmHg and the mean DBP ± SD (range) was 74.84 ± 10.70 (42–108) mmHg. The mean BP difference between observers and devices was 0.66 ± 6.81 mmHg for SBP and −0.96 ± 6.33 mmHg for DBP. The SD of the averaged pair determination per individual was ±4.45 mmHg for SBP and ±3.46 mmHg for DBP. The accuracy of the timer-triggered device was found to be acceptable when evaluated according to the ISO 81060-2: 2018 guidelines.

Conclusion

An automated sphygmomanometer, Uright model TD 3127AT, TaiDoc Technology Corporation, with timer trigger modification passed the ISO 81060-2:2018 guidelines.
Utility of ultrasound as a promising diagnostic tool for stroke-related sarcopenia: A retrospective pilot study
Authors: Park Siha , Kim Yuntae , Kim Soo A , Hwang Insu , Kim Doh-Eui
Published: September 2022

Stroke patients undergo extensive changes in muscle mass which lead to stroke-related sarcopenia. Stroke-related sarcopenia has a significant impact on the functional outcome of stroke survivors. So, it is important to measure muscle mass in stroke patients. This study aimed to examine the correlation between ultrasonographic quadriceps muscle thickness (QMT) and dual-energy X-ray absorptiometry (DXA) derived appendicular lean mass (ALM) in patients with acute hemiplegic stroke. Twenty five participants were included (13 men and 12 women) in this study, who were diagnosed with stroke within 1 month. For both paretic and non-paretic legs, QMT was measured by an ultrasound and ALM was obtained by performing DXA scan. We analyzed the difference and the correlation between ultrasonographic QMT and DXA-derived lean body mass of both paretic and non-paretic legs. Stroke patients were divided into 2 groups according to the paretic knee extensor power. Ultrasonographic QMT, DXA scan findings, and functional parameters were compared. There was a significant correlation between QMT and ALM index, and between QMT and site-specific lean mass (SSLM) of both the legs for both the sexes (P < .05). In multivariate linear regression model, we made adjustments for the confounding factors of age, sex, body mass index (BMI) and paretic knee extensor power. We observed a positive relationship between QMT and ALM index (P < .05), and between QMT and SSLM of both the legs (P < .05). The % QMT showed higher difference than % SSLM between paretic and non-paretic legs (10.25% vs 4.58%). The QMT measurements of ultrasound show a great relationship with DXA scan findings. Ultrasound better reflects the change of muscle mass between paretic and non-paretic legs than DXA scan at an acute phase of stroke. Ultrasound could be a useful tool to evaluate stroke-related sarcopenia.
Black pleural effusion caused by a pancreaticopleural fistula associated with autoimmune pancreatitis: A case report
Authors: Miyadera Keiki , Hisakane Kakeru , Kato Yuki , Atsumi Kenichiro , Ono Hiroki , Tanaka Shu , Kubota Kaoru , Seike Masahiro , Gemma Akihiko , Hirose Takashi
Published: September 2022

Rationale:

Black pleural effusion is a rare medical condition and a diagnostic marker. Pancreaticopleural fistula is one of the causes of black pleural effusion. Thus far, black pleural effusions caused by pancreaticopleural fistulae have mostly been reported in patients with alcohol-induced chronic pancreatitis. In this report, we present a case of black pleural effusion caused by a pancreaticopleural fistula associated with autoimmune pancreatitis.

Patient concerns and diagnosis:

A 59-year-old female without a history of alcohol drinking presented to our hospital with a chief complaint of dyspnea, as well as chest and back discomfort. She had left pleural effusion, and thoracentesis showed black pleural effusion. Computed tomography revealed the presence of encapsulated fluid from the pancreatic tail to the left pleural cavity, which was diagnosed as a pancreaticopleural fistula. It also showed diffuse pancreatic swelling. Serum testing showed a high IgG4 level (363 mg/dL). These findings led to the diagnosis of autoimmune pancreatitis.

Interventions and outcome:

The patient underwent endoscopic pancreatic sphincterotomy and pancreatic duct stent placement and received treatment with steroids. After treatment, there was no further accumulation of pleural effusion observed.

Conclusion:

This is the first report of black pleural effusion due to a pancreaticopleural fistula associated with autoimmune pancreatitis. The characteristic appearance of black pleural effusion may assist diagnosis. We report this case to emphasize that autoimmune pancreatitis can be a cause of black pleural effusion.
Role of EZH2 in adipogenesis and obesity: Current state of the art and implications – A review
Authors: Wang Haixia
Published: September 2022

Obesity is characterized by excessive accumulation of adiposity and has been implicated in a strong predisposition to metabolic disorders and cancer, constituting one of the major public health issues worldwide. The formation of new mature adipocytes through differentiation of progenitor or precursor cells during adipogenesis can lead to the expansion of adipose tissue. Recent studies have revealed that the intrinsic risk of obesity arises not only through genetic variants but also through epigenetic predisposition. Enhancer of zeste homolog 2 (EZH2) is an enzymatic catalytic component of polycomb repressive complex 2 that acts as an epigenetic modulator in the regulation of gene expression. EZH2 can modulate the expression of its target genes by the trimethylation of Lys-27 in histone 3 or methylation of non-histone proteins. Emerging evidence has shown the important role played by EZH2 in adipogenesis and obesity. This review provides the latest knowledge about the involvement of EZH2 in the process of adipogenesis and obesity involving adipocyte differentiation, extract key concepts, and highlight open questions toward a better understanding of EZH2 function and the molecular mechanisms underlying obesity.
Relative safety and efficacy of topical and oral NSAIDs in the treatment of osteoarthritis: A systematic review and meta-analysis
Authors: Wang Yuhui , Fan Miaozhen , Wang Huideng , You Yi , Wei Chengqiong , Liu Meng , Luo Ailin , Xu Xiaotian , Duan Xiaoqun
Published: September 2022

Background:

Osteoarthritis (OA) often affects the hands, knees, and hip joints, causing considerable pain and disability, and often affecting the patient’s quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are common pain relievers often applied as first line therapies for OA. However, prolonged NSAIDs application can have unwanted side effects. Given this, this study was designed to systematically evaluate the efficacy and safety of topical and oral NSAIDs for the treatment of OA.

Methods:

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for relevant papers from their inception dates to May 2021. Our study only included randomized controlled trials comparing topical and oral NSAIDs and all data were analyzed using Review Manager version 5.3 (RevMan version 5.3).

Results:

We identified 8 RCTs (2096 patients with OA), for evaluation and revealed that, in general, topical and oral NSAIDs presented with similar efficacies for the treatment of OA. The Western Ontario and McMaster Osteoarthritis Index for assessing pain relief in OA patients was (standardized mean difference [SMD] 0.07; 95%CI −0.02, 0.17) and visual analog scale was (SMD −0.01; 95%CI −0.02, 0.18), and improved stiffness in OA patients (SMD 0.09; 95%Cl 0.03, 0.20).

Conclusions:

Topical NSAIDs are as effective as oral NSAIDs for the treatment of OA and both topical and oral NSAIDs are equally effective in reducing pain and improving physical function in OA patients. In terms of safety, a larger number of samples are still needed to determine if there are any differences in the safety profile of topical or oral NSAIDs.

Registration number:

INPLASY 2021110009.
Laboratory characteristics of IgG4-related disease: A retrospective study from a single tertiary medical center
Authors: Cho Hanwool , Lee Jeong Joong , Kim Myungshin , Oh Eun-Jee , Kim Yonggoo , Chae Hyojin
Published: September 2022

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition with unique histopathological features that can affect most organs, making diagnosis challenging. This study characterized detailed laboratory characteristics of IgG4-RD.

Baseline clinical and laboratory features of 33 patients with IgG4-RD were reviewed, including serum IgG4 concentrations, serum free light chains (sFLCs), IgGĸ- and IgGλ-heavy/light chains (HLCs), capillary serum protein electrophoresis (SPE), and immunofixation electrophoresis (IFE) of IgG4 subclass.

The cohort of 33 patients showed male predominance (94%), with 8 (24%) exhibiting multiple organ involvement. Most patients (88%) had an elevated IgG4 concentration, and 67% had elevated erythrocyte sedimentation rate and IgE levels. Median IgG4 concentration at baseline was significantly higher in patients with >2 organs involved than those with ≤2. Furthermore, erythrocyte sedimentation rate was significantly correlated with serum IgG4 concentrations at baseline. SPE results demonstrated polyclonal gammopathy in most patients. Half of the patients had an increased κ/λ sFLC ratio, 42% had an increased IgGκ/IgGλ HLC ratio. Most patients exhibited hypergammaglobulinemia in the anodal end of the ɤ region on SPE.

This study describes detailed laboratory features of IgG4-RD. Although none of these tests are considered diagnostically sufficient by itself, the provided laboratory characteristics can increase awareness of this disorder and help distinguish it from other IgG4-RD mimics.
Microarray data analysis to identify miRNA biomarkers and construct the lncRNA-miRNA-mRNA network in lung adenocarcinoma
Authors: Song Yongan , Kelava Leonardo , Zhang Lu , Kiss István
Published: September 2022

MicroRNAs (miRNAs), regulatory noncoding RNAs, are involved in gene regulation and may play a role in cancer development. The aim of this study was to identify miRNAs involved in lung adenocarcinoma (LUAD) using bioinformatics analysis. MiRNA (GSE135918), mRNA (GSE136043) and lncRNA (GSE130779) microarray datasets were downloaded from the Gene Expression Omnibus (GEO) database to identify differentially expressed miRNAs (DEMis), mRNAs (DEMs), and lncRNA (DELs) in LUAD. We used DEMs for functional enrichment analysis. MiRNA expression quantification from The Cancer Genome Atlas (TCGA) was used to validate DEMis. LncBase Predicted v.2, Targetscan, and MiRBase were used to predict lncRNAs and mRNAs. The LUAD data in TCGA were used for overall survival (OS) analysis. We screened the downregulation of 8 DEMis and upregulation of 6 DEMis, and found that 70 signal pathways changed. We chose 3 relevant signaling pathways in lung cancer development, WNT, PI3K-Akt, and Notch, and scanned for mRNAs involved in them that are potential targets of these miRNAs. Then a lncRNA-miRNA-mRNA network was constructed. We also found 7 miRNAs that were associated with poor OS in LUAD. Low expression level of hsa-miR-30a was highly associated with poor OS in LUAD (P < .001) and the target genes of hsa-miR-30a-3p were abundant in the Wnt and AKT signaling pathways. In addition, our results reported for the first time that hsa-miR-3944 and hsa-miR-3652 were highly expressed in LUAD. And the high expression level of hsa-miR-3944 was associated with poor OS (P < .05). Hsa-miR-30a-3p may suppress the occurrence and progression of lung cancer through Wnt and AKT signaling pathways and become a good biomarker in LUAD. Hsa-miR-3944 and hsa-miR-3652 may serve as new biomarkers in LUAD.
Effectiveness of educational interventions for quality of life of parents and children with food allergy: A systematic review
Authors: Cheon Jooyoung , Cho Chung Min , Kim Hyo Jin , Kim Dong Hee
Published: September 2022

Background:

Educational intervention along with medical treatment is important to improve the quality of life of children with food allergies and their parents. This systematic review was designed to investigate the effects of education programs for parents and children with food allergies to provide a direction for developing an intervention program to improve their quality of life.

Methods:

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies published between January 2010 and August 2021 were identified through a systematic search of 5 databases (PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trial, and Psycho Info).

Results:

A total of 2351 articles were identified. Of these, 9 met the inclusion criteria after duplicates were removed. Among these, only 2 studies, using the support and handbook provided, showed significant results on quality of life.

Discussion:

There is a lack of educational interventions for children with food allergies and their parents. Educational intervention, an essential intervention, can maximize medical treatment and improve overall quality of life. Hence, these interventions should be actively developed and applied in the future.
Scoring systems for predicting clinical outcomes in peptic ulcer bleeding
Authors: Noh Jin Hee , Cha Boram , Ahn Ji Yong , Na Hee Kyong , Lee Jeong Hoon , Jung Kee Wook , Kim Do Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong
Published: September 2022

Few studies have focused on assessing the usefulness of scoring systems such as the Rockall score (RS), Glasgow–Blatchford score (GBS), and AIMS65 score for risk stratification and prognosis prediction in peptic ulcer bleeding patients. This study aimed to assess scoring systems in predicting clinical outcomes of patients with peptic ulcer bleeding. A total of 682 peptic ulcer bleeding patients who underwent esophagogastroduodenoscopy between January 2013 and December 2017 were found eligible for this study. The area under the receiver-operating characteristic curve (AUROC) of each score was calculated for predicting rebleeding, hospitalization, blood transfusion, and mortality. The median age of patients was 64 (interquartile range, 56–75) years. Of the patients, 74.9% were men, and 373 underwent endoscopic intervention. The median RS, GBS, and AIMS65 scores were significantly higher in patients who underwent endoscopic intervention than in those who did not. The AUROC of RS for predicting rebleeding was significantly higher than that of GBS (P = .022) or AIMS65 (P < .001). GBS best predicted the need for blood transfusion than either pre-RS (P = .013) or AIMS65 (P = .001). AIMS65 score showed the highest AUROC for mortality (0.652 vs. 0.622 vs. 0.691). RS was significantly associated with rebleeding (odds ratio, 1.430; P < .001) and overall survival (hazard ratio, 1.217; P < .001). The RS, GBS, and AIMS65 scoring systems are acceptable tools for predicting clinical outcomes in peptic ulcer bleeding. RS is an independent prognostic factor of rebleeding and overall survival.
To study the current status of uterine adhesions after fetal residue and the preventive effect of using estrogen and progesterone sequential therapy combined with Foley balloon
Authors: Liu Jie , Wang Shanshan , Li Shanshan , Liu Xuan
Published: September 2022

To investigate the current status of uterine adhesions in patients with residual fetus and analyze the preventive effect of estrogen and progesterone sequential therapy combined with Foley balloon. Eighty-six patients with residual fetus were divided into control group and observation group. On the basis of the treatment plan of the control group, the observation group received estrogen and progesterone sequential therapy combined with Floey balloon treatment. Clinical efficacy, postoperative recovery status (abdominal pain duration, vaginal bleeding duration, vaginal bleeding volume, refluid time), the incidence of intrauterine adhesions, uterine hemodynamics (uterine artery systolic maximum blood flow rate [Vmax], end diastolic blood flow rate [Vmin], resistance index [RI]), and the probability of complications were evaluated. Compared with the control group, the observation group achieved higher curative effect (P < .05); the observation group had shorter duration of abdominal pain, vaginal bleeding and refluid time, and lower vaginal bleeding (P < .05); the probability of intrauterine adhesions is lower (P < .05); before treatment, there is little difference in the levels of Vmax, Vmin, RI, and other indicators between the 2 groups (P > .05). After treatment, compared with the control group, the observation group Vmax, Vmin, and other indicators, the level was significantly lower, and the RI level was significantly higher (P < .05); the observation group had a lower probability of complications (P < .05). The likelihood of uterine adhesions after fetal remains is increased. The use of estrogen and progesterone sequential therapy in conjunction with Foley balloon therapy can improve treatment efficacy, improve uterine adhesion prevention, and promote patient recovery after surgery.
Immunosuppressive therapy versus supportive care in IgA nephropathy patients with stage 3 and 4 chronic kidney disease
Authors: Ștefan Gabriel , Stancu Simona , Zugravu Adrian , Petre Nicoleta , Secăreanu Silviu , Popa Otilia , Capusa Cristina
Published: September 2022

The use of immunosuppressive therapy for immunoglobulin A nephropathy (IgAN) patients with stage 3 or 4 chronic kidney disease (CKD) is controversial. We performed a monocentric retrospective study on 83 consecutive IgAN patients with stage 3 or 4 CKD and proteinuria ≥0.75 g/d (age 41 [33–56] years, 72% male, estimated glomerular filtration rate 36.1 [25.4–47.5] mL/min/1.73 m2) who received uncontrolled supportive care (Supp) (n = 36), corticosteroids/corticotherapy (CS) (n = 14), or CS combined with monthly pulses of cyclophosphamide (CS + CFM) (n = 33) between 2010 and 2017. Patients were followed until composite endpoint (doubling of serum creatinine, end-stage kidney disease (dialysis or kidney transplant) or death, whichever came first) or end of study (January 2020). Patients were followed for a median of 29 (95% confidence interval = 25.2–32.7) months, and 12 (15%) patients experienced the composite endpoint. Within the limitation of a retrospective study, our results suggest no benefit from immunosuppressive therapy in patients with IgAN with stage 3 and 4 CKD as compared with supportive care.

There were no differences between the 3 studied groups regarding age, estimated glomerular filtration rate, proteinuria, Oxford classification score, arterial hypertension, and therapy with renin-angiotensin system inhibitors.

Mean kidney survival time for the entire cohort was 81.0 (95% confidence interval = 73.1–89.0) months, without significant differences between the 3 groups.

In univariate and multivariate Cox regression analysis adjusted for IgAN progression factors, immunosuppressive therapy was not associated with better kidney survival when compared with supportive therapy.
Prognosis of patients with cardiogenic shock following acute myocardial infarction: The difference between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction
Authors: Tsai Ming-Lung , Hsieh Ming-Jer , Chen Chun-Chi , Wu Victor Chien-Chia , Lan Wen-Ching , Huang Yu-Tung , Hsieh I-Chang , Chang Shang-Hung
Published: September 2022

Acute myocardial infarction (AMI) complicated by cardiogenic shock has high mortality and remains challenging even in the revascularization era. We conducted this study to understand patients’ outcomes. We retrospectively analyzed electronic medical records data from 1175 patients with AMI complicated by cardiogenic shock that developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. Patients with AMI were classified into the ST-segment elevation MI (STEMI) group or the non-ST-segment elevation MI (NSTEMI) group. The short-term and 1-year mortality and adverse events after index admission were analyzed via logistic regression and a Cox proportional hazards model. When compared with NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 years vs 70.70 ± 12.99 years, P < .001), men (73.29% vs 60.87%, P < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident during the admission period. However, the major and gastrointestinal bleeding rates were higher in the STEMI group (2.66% vs 0.22%, P = .014; 3.36% vs 0.22%, P = .007, respectively). Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis. In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in short-term results.
Ultrasonographic misdiagnosis of multicystic mesothelioma of the omentum: A case report
Authors: Diao Yuhong , Chen Li , Liu Zhixing
Published: September 2022

Rationale:

Multicystic Mesothelioma (MM) is very rare and preoperative diagnosis is difficult.

Patient concerns:

We report a case of a 34-year-old man with solid abdominal cystic echo mass. Physical examination showed that the patient had a flat and soft abdomen without tenderness or rebound pain, no fluid wave tremor, and no obvious abdominal mass was touched. The patient complained of repeated abdominal distention with nausea for 5 days. Sonographic examination suspected pseudomyxoma peritoneum.

Diagnosis:

Conventional ultrasound examination showed a cystic solid echo mass in the right abdominal cavity of the patient, with uneven internal echo and honeycomb change, and clear boundary with surrounding organs. Color Doppler suggested that the blood flow in the mass was not obvious. Contrast-enhanced computed tomography of the abdomen revealed hypodensity foci in hepatic and renal crypts and right paracolic sulcus.

Interventions:

Laparoscopic resection of the mass was performed, and the postoperative pathological findings were polycystic mesothelioma (greater omentum).

Outcomes:

After mass resection, all laboratory tests and abdominal ultrasound were normal, and abdominal distension and nausea disappeared.

Lessons:

Improved ultrasound diagnosis of MM is useful for clinical decision-making.
Retention rate of secukinumab in psoriatic arthritis: Real-world data results from a Spanish multicenter cohort
Authors: Valero-Expósito Marta , Martín-López María , Guillén-Astete Carlos , Joven Beatriz , Merino-Argumanez Carolina , Emperiale Valentina , Campos Jose , Pérez Ana , Bachiller-Corral Javier
Published: September 2022

Secukinumab is a novel anti-IL17 biologic treatment approved for the treatment of psoriatic arthritis (PsA). The purpose of the present study is to identify factors that can condition the retention rate of this drug in a real-world scenario. Methods: A multicentric retrospective study was conducted based on the registries of consecutive patients diagnosed with PsA who started secukinumab from January 2016 to December 2018. For purposes of Cox-regression analysis, the time spanning from the first administration of secukinumab until its interruption or the end of the follow-up was considered the independent variable. Variables of known relevance and those who demonstrated direct association with the drug retention rate were included in the model. Results: One hundred seventy-six registries were analyzed (average age at diagnosis 44.7 ± 12.1 years old, 114 females). The median retention rate of secukinumab was 636 days (95% confidence interval [CI] 542.4–729.5). Presence of peripheral arthritis (hazard ratio 0.424 [95% CI 0.213–0.847, P = .015]) and a time of evolution >6 years (hazard ratio 0.468 [95% CI 0.225–0.975, P = .043]) were the 2 variables that showed a significant influence on the drug retention rate. According to our results, patients who exhibit peripheral arthritis and those with a higher evolution time will have more probabilities of a larger secukinumab retention rate.