bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between immunoglobulin A1 lectin-binding specificities, mesangial C4d deposits and clinical phenotypes in immunoglobulin A nephropathy
Authors: Medrano Alfons Segarra , Muijsemberg Andrea , Wimbury David , Martin Marisa , Jatem Elias , González Jorge , Colás-Campás Laura , García-Carrasco Alicia , Martínez Cristina , Barratt Jonathan
Published: December 2020

Background

The reason why mesangial C4d deposits are detected in only certain biopsies of immunoglobulin A nephropathy (IGAN) remains unclear. We analyse the association between IgA glycosylation patterns, mesangial C4 deposition and clinical phenotypes in IgAN.

Methods

This cross-sectional study included 145 patients with idiopathic IgAN. We measured the serum levels of three different IgA1 lectin-binding specificities using enzyme-linked immunosorbent assays with and without treatment with neuraminidase and we analysed the relationship between these glycoforms, C4d mesangial deposits and clinical phenotypes.

Results

C4d-positive versus Cd4-negative patients had higher proteinuria [median 3.1 g/g (0.9–4.2) versus 1.8 (1–2.2); P = 0.000], haematuria [223 cells/µL (32–278) versus 99 (25–186); P = 0.000] and higher levels of IgA binding to neuraminidase untreated Helix aspersa (HA IgA1 neu−; 150.6 ± 52 U versus 96.2 ± 64.1; P = 0.000), neuraminidase untreated Helix pomatia (HPA IgA1 neu−; 0.34 ± 0.15 U versus 0.27 ± 0.13; P = 0.04), Triticum vulgaris (TV IgA1; 85.1 ± 31.7 U versus 42.2 ± 26.9; P = 0.000) and Canavalia ensiformis (ConA IgA1; 32.5 ± 18 U versus 16.7 ± 9.38; P = 0.000). The levels of HA IgA1 neu−, HPA IgA1 neu−, TV IgA1 and ConA IgA1 were all associated with the mesangial deposition of C4d, extracapillary proliferation and acute kidney injury. In receiver operating characteristics curves, HA IgA1 neu−, HPA IgA1 neu−, TV IgA1 and ConA IgA1 significantly discriminated between C4d-positive ad C4d-negative biopsies. In logistics models, TV IgA1 and ConA IgA1 were the only independent predictors of mesangial C4d deposits.

Conclusions

In IgAN, the severity of the disease is associated with the level of IgA exposing N-acetyl-d-galactosamine, N-acetyl-d-glucosamine or mannose, whereas C4d deposits are only associated with elevated levels of IgA1 glycoforms exhibiting glycan residues with specificity for mannose and N-acetyl-d-glucosamine binding lectins.
Surjective Homomorphisms from Algebras of Operators on Long Sequence Spaces are Automatically Injective
Authors: HorvÁth Bence , Kania Tomasz
Published: December 2020

We study automatic injectivity of surjective algebra homomorphisms from $\mathscr{B}(X)$, the algebra of (bounded, linear) operators on X, to $\mathscr{B}(Y)$, where X is one of the following long sequence spaces: c0(λ), $\ell_{\infty}^c(\lambda)$, and $\ell_p(\lambda)$ ($1 \leqslant p \lt \infty$) and Y is arbitrary. En route to the proof that these spaces do indeed enjoy such a property, we classify two-sided ideals of the algebra of operators of any of the aforementioned Banach spaces that are closed with respect to the ‘sequential strong operator topology’.
Gradient Estimates of ω-Minimizers to Double Phase Variational Problems with Variable Exponents
Authors: Byun Sun-Sig , Lee Ho-Sik
Published: December 2020

We are concerned with an optimal regularity for ω-minimizers to double phase variational problems with variable exponents where the associated energy density is allowed to be discontinuous. We identify basic structure assumptions on the density for the absence of Lavrentiev phenomenon and higher integrability. Moreover, we establish a local Calderón–Zygmund theory for such generalized minimizers under minimal regularity requirements regarding such double phase functionals to the frame of Lebesgue spaces with variable exponents.
Clinical Usefulness of Acute-Phase Markers in Distinguishing between PFAPA and Other Exudative Tonsillitis Causes: A Methodological Study
Authors: Kanik Ali , Eliacik Kayı , Kanik Esra Toprak , Tekindal Mustafa Agah
Published: December 2020

Background

We investigated the practical use of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and complete blood count (CBC) parameters in distinguishing periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA) attacks from exudative tonsillitis associated with group A streptococcus (GAS) and Epstein–Barre virus (EBV).

Methods

The study population consisted of cases with exudative tonsillitis who had been subsequently diagnosed as PFAPA, EBV, and GAS tonsillitis through a period of 6 years. We retrieved the CBC, ESR, CRP and PCT data from patients’ medical records.

Results

Of the patients, 47 (35.6%) had PFAPA, 36 (27.3%) had GAS and 49 (37.1%) had EBV tonsillitis. Median CRP, ESR and PCT values of patients with PFAPA were 78 (17–92) mg/dl, 44 (11–83) mm/h, 0.16 (0.01–1.45) ng/ml, respectively. The CRP and ESR levels were significantly higher in PFAPA and GAS groups compared with the EBV group (p = 0.001). There was no significant difference between the groups regarding the PCT levels.

Conclusion

The study indicated no benefit of PCT in distinguishing PFAPA from the others. However, we found that CRP, ESR, and CBC parameters could be useful in identifying PFAPA and GAS than EBV tonsillitis.
Wheat Thioredoxin (TaTrxh1) Associates With RD19-Like Cysteine Protease TaCP1 to Defend Against Stripe Rust Fungus Through Modulation of Programmed Cell Death
Authors: Shi Beibei , Zhao Xinbei , Li Min , Dong Zihui , Yang Qichao , Wang Yang , Gao Haifeng , Day Brad , Ma Qing
Published: December 2020

Thioredoxins (Trxs) function within the antioxidant network through modulation of one or more redox reactions involved in oxidative-stress signaling. Given their function in regulating cellular redox, Trx proteins also fulfill key roles in plant immune signaling. Here, TaTrxh1, encoding a subgroup h member of the Trx family, was identified and cloned in wheat (Triticum aestivum), which was rapidly induced by Puccinia striiformis f. sp. tritici invasion and salicylic acid (SA) treatment. Overexpression of TaTrxh1 in tobacco (Nicotiana benthamiana) induced programmed cell death. Silencing of TaTrxh1 in wheat enhanced susceptibility to P. striiformis f. sp. tritici in different aspects, including reactive oxygen species accumulation and pathogen-responsive or -related gene expression. Herein, we observed that the cellular concentration of SA was significantly reduced in TaTrxh1-silenced plants, indicating that TaTrxh1 possibly regulates wheat resistance to stripe rust through a SA-associated defense signaling pathway. Using a yeast two-hybrid screen to identify TaTrxh1-interacting partners, we further show that interaction with TaCP1 (a RD19-like cysteine protease) and subsequent silencing of TaCP1 reduced wheat resistance to P. striiformis f. sp. tritici. In total, the data presented herein demonstrate that TaTrxh1 enhances wheat resistance against P. striiformis f. sp. tritici via SA-dependent resistance signaling and that TaTrxh1 interaction with TaCP1 is required for wheat resistance to stripe rust.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Taking Advantage of Pathogen Diversity and Immune Priming to Minimize Disease Prevalence in Host Mixtures: A Model
Authors: Clin Pauline , Grognard Frédéric , Mailleret Ludovic , Val Florence , Andrivon Didier , Hamelin Frédéric M.
Published: December 2020

Host mixtures are a promising method for agroecological plant disease control. Plant immunity is key to the success of host mixtures against polymorphic pathogen populations. This immunity results from priming-induced cross-protection, whereby plants able to resist infection by specific pathogen genotypes become more resistant to other pathogen genotypes. Strikingly, this phenomenon was absent from mathematical models aiming at designing host mixtures. We developed a model to specifically explore how priming affects the coexistence of two pathogen genotypes in host mixtures composed of two host genotypes and how it affects disease prevalence. The main effect of priming is to reduce the coexistence region in the parameter space (due to the cross-protection) and to generate a singular mixture of resistant and susceptible hosts corresponding to the maximal reduction disease prevalence (in absence of priming, a resistant pure stand is optimal). The epidemiological advantage of host mixtures over a resistant pure stand thus appears as a direct consequence of immune priming. We also showed that there is indirect cross-protection between host genotypes in a mixture. Moreover, the optimal mix prevents the emergence of a resistance-breaking pathogen genotype. Our results highlight the importance of considering immune priming to design optimal and sustainable host mixtures.
Cellular interactions in aspirin-exacerbated respiratory disease
Authors: Badrani Jana H. , Doherty Taylor A.
Published: December 2020

Purpose of review

The purpose of this review is to summarize the complex cellular interactions of aspirin-exacerbated respiratory disease (AERD) and how these interactions promote pathogenic mechanisms of AERD.

Recent findings

In addition to characteristic changes in eicosanoid levels, recent studies have identified increases in alarmin cytokines (IL-33, thymic stromal lymphopoietin) as well as activated innate lymphoid and plasma cell populations in samples from AERD patients.

Patients with AERD typically demonstrate high levels of proinflammatory eicosanoids including cysteinyl leukotrienes (CysLTs) and prostaglandin D2 (PGD2) and hyporesponsiveness to prostaglandin E2 (PGE2). CysLTs are released by mast cells, eosinophils, and adherent platelets and promote epithelial release of IL-33, which activates mast cells and group 2 innate lymphoid cells (ILC2s) in concert with CysLTs. TSLP induces PGD2 release from mast cells which activates and recruits eosinophils, basophils, Th2 cells, and ILC2s via CRTH2. In turn, ILC2s and other cell types produce Th2 cytokines IL-4, IL-5, and IL-13 that, along with CysLTs and PGD2, promote bronchoconstriction, eosinophilic tissue inflammation, and mucus production.
The Distinguished Teaching Society at the Johns Hopkins University School of Medicine: A Student-Led Initiative to Recognize Clinical Educators
Authors: Gupta Pranjal Bodh , McRae Ashlyn Elizabeth , Franke Jennifer Lynn , Saba James A. , Soroosh Garshasb Parkhideh , Solomon Barry S. , Cofrancesco Joseph
Published: December 2020

Problem

Some focus on recognizing excellence in clinical teaching has been lost with the increasing emphasis placed on clinical efficiency and value. Clinical teaching awards and academies of educators aim to address this problem. In 2015, medical student leaders at the Johns Hopkins University School of Medicine created the Distinguished Teaching Society (DTS), a student-driven program to recognize the best clinical educators.

Approach

Medical students designed a comprehensive scoring rubric focusing on 3 domains: feedback and evaluation, role model behavior, and teaching process. A student committee solicits student nominations providing narratives endorsing faculty or house staff for potential inclusion in the DTS. Using the rubric, student judges score each deidentified narrative nomination, as well as an application from finalists and comments about finalists submitted by the student body. Inductees are recognized at an annual ceremony.

Outcomes

From academic years 2015–2016 to 2018–2019, students nominated 254 unique candidates, and 82 nominees (32%) were inducted into the DTS. The majority of inductees were faculty and male. In 2017–2018 and 2018–2019, nearly half of inductees were female, and less than 10% of inductees self-reported as underrepresented in medicine and/or LGBTQ+. The Department of Internal Medicine had the greatest departmental representation. There were no statistically significant differences in the proportional representation within the nomination and inductee cohorts by gender, rank, and department. Several process changes were made in response to student feedback and to increase nominee and inductee diversity.

Next Steps

Next steps include adding a diversity and inclusion chair to the student committee and collecting survey data on student and DTS inductee opinions on how to improve learner–teacher engagement and the clinical learning environment. Future activities may include educational workshops, panel discussions, mentorship programs, and networking events. Other medical schools may find value in considering similar structures.
Using Predictive Modeling and Machine Learning to Identify Patients Appropriate for Outpatient Anterior Cervical Fusion and Discectomy
Authors: Wang Kevin Y. , Suresh Krishna V. , Puvanesarajah Varun , Raad Micheal , Margalit Adam , Jain Amit
Published: December 2020

Study Design.

Retrospective, case–control.

Objective.

The aim of this study was to use predictive modeling and machine learning to develop novel tools for identifying patients who may be appropriate for single-level outpatient anterior cervical fusion and discectomy (ACDF), and to compare these to legacy metrics.

Summary of Background Data.

ACDF performed in an ambulatory surgical setting has started to gain popularity in recent years. Currently there are no standardized risk-stratification tools for determining which patients may be safe candidates for outpatient ACDF.

Methods.

Adult patients with American Society of Anesthesiologists (ASA) Class 1, 2, or 3 undergoing one-level ACDF in inpatient or outpatient settings were identified in the National Surgical Quality Improvement Program database. Patients were deemed as “unsafe” for outpatient surgery if they suffered any complication within a week of the index operation. Two different methodologies were used to identify unsafe candidates: a novel predictive model derived from multivariable logistic regression of significant risk factors, and an artificial neural network (ANN) using preoperative variables. Both methods were trained using randomly split 70% of the dataset and validated on the remaining 30%. The methods were compared against legacy risk-stratification measures: ASA and Charlson Comorbidity Index (CCI) using area under the curve (AUC) statistic.

Results.

A total of 12,492 patients who underwent single-level ACDF met the study criteria. Of these, 9.79% (1223) were deemed unsafe for outpatient ACDF given development of a complication within 1 week of the index operation. The five clinical variables that were found to be significant in the multivariable predictive model were: advanced age, low hemoglobin, high international normalized ratio, low albumin, and poor functional status. The predictive model had an AUC of 0.757, which was significantly higher than the AUC of both ASA (0.66; P < 0.001) and CCI (0.60; P < 0.001). The ANN exhibited an AUC of 0.740, which was significantly higher than the AUCs of ASA and CCI (all, P < 0.05), and comparable to that of the predictive model (P > 0.05).

Conclusion.

Predictive analytics and machine learning can be leveraged to aid in identification of patients who may be safe candidates for single-level outpatient ACDF. Surgeons and perioperative teams may find these tools useful to augment clinical decision-making.

Level of Evidence: 3
Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)
Authors: Chan Chris Yin Wei , Lee Sin Ying , Ch’ng Pei Ying , Chung Weng Hong , Chiu Chee Kidd , Hasan Mohd Shahnaz , Kwan Mun Keong
Published: December 2020

Study Design.

Retrospective study.

Objective.

To assess the learning curve of a dual attending surgeon strategy in severe adolescent idiopathic scoliosis patients.

Summary of Background Data.

The advantages of a dual attending surgeon strategy in improving the perioperative outcome in scoliosis surgery had been reported. However, the learning curve of this strategy in severe scoliosis had not been widely studied.

Methods.

A total of 105 patients with adolescent idiopathic scoliosis with Cobb angle of 90° or greater, who underwent posterior spinal fusion using a dual attending surgeon strategy were recruited. Primary outcomes were operative time, total blood loss, allogeneic blood transfusion requirement, length of hospital stay from time of operation and perioperative complications. Cases were sorted chronologically into group 1: cases 1 to 35, group 2: cases 36 to 70, and group 3: case 71 to 105. Mean operative time (≤193.3 min), total blood loss (≤1612.2 mL), combination of both and allogeneic blood transfusion were the selected criteria for receiver operating characteristic analysis of the learning curve.

Results.

The mean Cobb angle was 104.5° ± 12.3°. The operative time, total blood loss, and allogeneic blood transfusion requirement reduced significantly for group 1 (220.6 ± 54.8 min; 2011.3 ± 881.8 mL; 12 cases) versus group 2 (183.6 ± 36.7 min; 1481.6 ± 1035.5 mL; 3 cases) and group 1 versus group 3 (175.6 ± 38.4 min; 1343.7 ± 477.8 mL; 3 cases) (P < 0.05). There were six perioperative complications. Fifty-seven cases were required to achieve the preset criteria (mean operative time and mean total blood loss) (area under the curve 0.740; P < 0.001; sensitivity 0.675; specificity 0.662).

Conclusion.

There was significant improvement in operative time and total blood loss when comparing group 1 versus group 2 and group 1 versus group 3. The cut-off point for the learning curve was 57 cases when the preset criteria were fulfilled (≤193.3 min operative time and ≤1612.2 mL of total blood loss).

Level of Evidence: 4
Case Report and Review of 7 Similar Cases in the Literature: Cutaneous Sarcoidosis as Side Effect of Pembrolizumab Plus Chemotherapy in Stage IV Squamous Cell Carcinoma of Lung
Authors: Trilleras-Gomez Angelica P. , Hull Kimberly J. , Drew David Z.
Published: December 2020

Advanced squamous cell lung cancer used to have universally dismal long-term outcomes before the use of immune checkpoint inhibitors (ICIs). Due to the expanding role of ICIs, there has been an increasing number of long-term survivors in this relatively large group of patients. ICIs such as anti-cytotoxic T-lymphocyte–associated protein 4 and anti-programmed cell death protein 1/programmed death-ligand 1 monoclonal antibodies increase the T-cell activation and limit the tumor capacity to escape the adaptive immune response. However, efficacy comes along with unique immune-related adverse events. We present an unusual case of cutaneous sarcoidosis in a 63-year-old white female who was diagnosed with stage IV squamous cell lung cancer developed skin manifestations 3 months after started chemo/pembrolizumab. Sarcoidosis was confirmed by skin punch biopsy and resolved after a short course of systemic glucocorticoid while maintained on pembrolizumab with lower frequency. These sarcoid-like lesions associated with the blockage of programmed death receptor-1 have been increasingly described in many different malignancies especially in melanoma. There is a need for further investigation to the characterization of the population prone to this immune-related adverse events.
Dispersion in the hospital network of shared patients is associated with less efficient care
Authors: Everson Jordan , Adler-Milstein Julia R. , Hollingsworth John M. , Lee Shoou-Yih D.
Published: December 2020

Background

There is growing recognition that health care providers are embedded in networks formed by the movement of patients between providers. However, the structure of such networks and its impact on health care are poorly understood.

Purpose

We examined the level of dispersion of patient-sharing networks across U.S. hospitals and its association with three measures of care delivered by hospitals that were likely to relate to coordination.

Methodology/Approach

We used data derived from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common. We then calculated a measure of dispersion for each hospital based on how those patients were concentrated in outside hospitals. Using this measure, we created multivariate regression models to estimate the relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates.

Results

In multivariate analysis, we found that hospitals with more dispersed networks (those with many low-volume patient-sharing relationships) had higher spending but not greater readmission rates or slower ED throughput. Among hospitals with fewer resources, greater dispersion related to greater readmission rates and slower ED throughput. Holding an individual hospital’s dispersion constant, the level of dispersion of other hospitals in the hospital’s network was also related to these outcomes.

Conclusion

Dispersed interhospital networks pose a challenge to coordination for patients who are treated at multiple hospitals. These findings indicate that the patient-sharing network structure may be an overlooked factor that shapes how health care organizations deliver care.

Practice Implications

Hospital leaders and hospital-based clinicians should consider how the structure of relationships with other hospitals influences the coordination of patient care. Effective management of this broad network may lead to important strategic partnerships.
ASSOCIATION BETWEEN PLATELET INDICES AND RETINAL VEIN OCCLUSION
Authors: Liu Zhengyang , Perry Luke A. , Edwards Thomas L.
Published: December 2020

Purpose:

Platelet count, mean platelet volume, platelet distribution width, and plateletcrit are standard indices of platelet activation that have been studied in retinal vein occlusion (RVO) and its subtypes: branch retinal vein occlusion and central retinal vein occlusion. This systematic review and meta-analysis aimed to assess the association between these platelet parameters and RVO.

Methods:

We searched for studies investigating the association between these platelet indices and RVO in multiple online databases from inception to August 2020. Mean differences and the associated confidence intervals were obtained and calculated for each included study and pooled using random-effects inverse variance modeling. Meta-regression was used to explore interstudy and intrastudy heterogeneity.

Results:

Thousand three hundred and twenty-five unique studies were screened, from which 24 studies encompassing 2,718 patients were included. Mean platelet volume and platelet distribution width were significantly elevated in RVO, with pooled mean differences of 0.45 fL (95% CI 0.24–0.66, P < 0.0001) and 1.43% (95% CI 0.57–2.29, P = 0.0011), respectively. Platelet count and plateletcrit were not significantly associated with RVO. Mean platelet volume was also independently elevated in branch retinal vein occlusion and central retinal vein occlusion.

Conclusion:

Mean platelet volume and platelet distribution width are significantly elevated in RVO. Further research is required to explore the independence and potential prognostic significance of these associations.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS BEFORE AND AFTER VITRECTOMY FOR MACULAR HOLES
Authors: Savastano Alfonso , Bacherini Daniela , Savastano Maria C. , Finocchio Lucia , Dragotto Francesco , Lenzetti Chiara , Moroni Rossana , Caporossi Tomaso , Rizzo Stanislao
Published: December 2020

Purpose:

To investigate the vascular remodeling of optical coherence tomography angiography in full-thickness macular hole surgery.

Methods:

This retrospective, observational case series included 33 eyes of 33 patients with a full-thickness macular hole who underwent epiretinal membrane removal. Data were collected on best-corrected visual acuity, structural B-scan optical coherence tomography, and optical coherence tomography angiography preoperatively and at 1, 3, and 6 months postoperatively. Optical coherence tomography angiography was used to assess the retinal vascular density (VD) of the superficial vascular plexus and deep vascular plexus (DVP). Vascular density was assessed using the Early Treatment Diabetic Retinopathy Study grid for the whole, inner, and outer grids.

Results:

A statistically significant correlation was found between the VD (whole, inner, and outer grids) of the superficial vascular plexus alone from baseline to 1-month postoperatively (P < 0.001). Similarly, VD was correlated from baseline to 1, 3, and 6 months postoperatively to the whole (P < 0.0005, F = 23.22), inner (P < 0.0005, F = 28.23), and outer Early Treatment Diabetic Retinopathy Study grids of DVP (P = 0.033, F = 3.49). The best-corrected visual acuity and VD were significantly correlated with the superficial vascular plexus and DVP at baseline and 6 months (P < 0.05, all correlations). The most significant correlation was observed at 6 months between best-corrected visual acuity and DVP in the whole, inner, and outer Early Treatment Diabetic Retinopathy Study grids (P < 0.001).

Conclusion:

Superficial vascular plexus and DVP are affected by full-thickness macular holes, with the most significant effects being on the DVP. Full-thickness macular hole surgery leads to an improvement in the best-corrected visual acuity in many eyes and the restoration of the VD, especially of the DVP.
Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?
Authors: Malhotra Amisha , Sturgill Marc , Whitley-Williams Patricia , Lee Yi-Horng , Esochaghi Chika , Rajasekhar Hariprem , Olson Birk , Gaur Sunanda
Published: December 2020

Background:

We describe the temporal pattern of COVID-19 admissions to a tertiary care children’s hospital in central New Jersey during the SARS-CoV-2 surge, covering the time period from March 29 to July 26, 2020.

Methods:

Medical charts were reviewed for the date of admission, past medical history, and demographic variables, presenting signs and symptoms, admitting laboratory values, diagnostic imaging, diagnosis, treatment modalities, and outcomes including length of stay and disease severity.

Results:

Patients with symptomatic SARS-CoV-2 infection tended to present with pneumonia early during the study period, which coincided with the early surge in New Jersey cases. Approximately 2 weeks after the peak in reported SARS-CoV-2 cases in New Jersey, we began to see fewer pneumonia cases and an increase in admissions for Multi-Inflammatory Syndrome in Children and cases of acute appendicitis in association with a diagnosis of SARS-CoV-2 infection.

Conclusions:

We present a novel association of acute appendicitis in children infected with SARS-CoV-2 and postulate that it may represent a postinfectious hyperinflammatory complication of SARS-CoV-2 infection occurring 2 weeks after the early manifestation of acute pneumonia disease in children.
High Prevalence of Non-Communicable Diseases Risk Factors in 36,074 South African Financial Sector Employees
Authors: Hene Nceba , Wood Paola , Schwellnus Martin , Jordaan Esme , Laubscher Ria
Published: December 2020

Objective:

To determine the prevalence of non-communicable disease (NCD) risk factors, total NCD risk category and 10-year risk for cardiovascular diseases (CVD) in financial sector employees.

Methods:

This descriptive observational cross-sectional analysis, data from 36,074 employees was analysed. NCD risk factor data was obtained from health risk assessments that included a questionnaire and clinical measures. The 10-year risk for CVD was calculated using the Framingham non-laboratory based equation.

Results:

Inadequate fruit and vegetable intake (89.3%), insufficient physical activity (77.4%), and being overweight (66.8%) were the most prevalent risk factors. Women had significantly higher prevalence ratios for central obesity (2.28; P < 0.001), insufficient physical activity (1.21; P < 0.001), hypercholesterolaemia (1.15; P < 0.001), and overweight (1.08; P < 0.001) compared with men.

Conclusion:

A more concerted effort is required to provide employees with appropriate tools and education at the workplace to decrease and manage NCDs.
A case report on concurrent occurrence of systemic mastocytosis and myeloid sarcoma presenting with extensive skin involvements and the results of genetic study
Authors: Wang Xinye , Zhang Lu , Zhou Daobin , Cai Hao , Wang Xuan , Jiang Xianyong
Published: December 2020

Introduction:

Systemic mastocytosis is a rare disease due to mast cell accumulation in various extracutaneous sites. Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease is the second most common subtype of systemic mastocytosis. The most common mutation associated with both systemic mastocytosis and myeloid sarcoma is mutation in Kit. Here, we identified the novel KIT D816V and ARID1A G1254S mutations co-occurring in systemic mastocytosis with myeloid sarcoma.

Patient Concerns:

A 33-year old male patient presented multiple skin lesions for 10 years. Symptoms accelerated in 2017 with decreased body weight. Physical examination revealed enlarged lymph nodes in his neck, axilla and inguinal region; conjunctival hemorrhage; gingival hyperplasia. Skin biopsy showed mast cell infiltration. Flow cytometry detected CD2, CD25 and CD117 positive cells in lymph nodes. Codon 816 KIT mutation D816V and codon 1245 ARID1A mutation G1254S were found in peripheral blood. MPO, CD117, CD68 positive cells in lymph nodes indicated co-existing myeloid sarcoma.

Diagnosis:

Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease of myeloid sarcoma

Interventions:

Cytarabine and daunorubicin for myeloid sarcoma and dasatinib for systemic mastocytosis were initiated. Anti-histamine and anti-leukotrienes therapy were used to prevent NSAIDs-induced shock. Platelets were infused to treat bone marrow suppression.

Outcomes:

Patient was discharged after recovered from bone marrow suppression. Dasatinib continued on outpatient.

Conclusion:

This is the first case of patient with systemic mastocytosis and myeloid sarcoma simultaneously presenting extensive skin involvements. Mutations of Kit and Arid1a emphasis the importance to notice possibility of various tumors occurring in patients with multiple mutations. In addition, cysteine-leukotrienes-receptor antagonists should always be used to prevent anaphylactic shock due to mast cell activation.
Primary leptomeningeal melanomatosis successfully treated with PD-1 inhibitor pembrolizumab
Authors: Misir Krpan Ana , Rakusic Zoran , Herceg Davorin
Published: December 2020

Rationale:

Primary leptomeningeal melanoma is an extremely rare disease of the central nervous system. There are no standard treatment protocols with a poor prognosis in very few reported cases. Immunotherapy in primary brain melanoma has not been successfully applied so far.

Patient concerns:

We describe a female patient 72-year-old diagnosed in the Neurosurgery Department which presented with generalized seizures.

Diagnoses:

Histological examination confirmed atypical melanocytes immunohistochemically positive for melan A, HMB45 and S-100 protein in the meninges, BRAF V600E negative. Dermatological, ophthalmological examinations, and 18-FDG PET/CT were negative.

Interventions:

The patient was successfully treated with pembrolizumab 2 mg/kg every 3 weeks for 2 years.

Outcomes:

The disease was stable for 2 years and the patient had no significant toxicity.

Lessons:

Our report describes durable intracranial tumor response suggesting the efficacy of PD-1 inhibitor pembrolizumab for central nervous system primary leptomeningeal melanoma.
Comparison of the efficacy of the anterolateral thigh flap for perforator localization in the repair of head and neck soft tissue defects patients
Authors: Sheng Jiangfeng , Li Chao , Tang Ping , Hu Jun , Ma Liying , Qin Gang
Published: December 2020

Background:

Head and neck tissue defects cause great physical and psychological damage to patients. Therefore, accurate positioning of perforating vessels before operation is of great significance for improving the success rate of flap preparation and avoiding unnecessary incision injury.

Methods/Design:

A total of 60 patients with laryngeal cancer in otolaryngology, Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University and the Third People's Hospital of Mianyang city from October 2020 to October 2021 will be selected and randomly divided into CT angiogram (CTA) group (n=20), mimics group (n = 20) and CTA + mimics group (n = 20) according to the numerical table. Patients in the CTA group will receive CTA examination of lower extremities. Patients in mimics group will receive digital technology in the positioning of perforator. Patients in CTA + mimics group will receive CTA + digital technology. All the patients will receive the flap cutting and the flap making; the doctor will determine the perforation branch of the flap with 3-D visual positioning, measure the preoperative indicators intraoperatively and complete the wound repair. Finally, the survival rate, sensitivity, specificity and accuracy of the flap will be measured.

Discussion:

The anterolateral thigh flap has been widely used to repair various tissue defects and has obtained good clinical results. The extensive clinical application mainly focuses on 2 aspects, namely the study of vascular anatomy of lateral flap and the exploration of preoperative flap design technology. Perforator is the direct blood supply source of anterolateral thigh flap, so it is particularly important to study the anatomy of perforator. Therefore, this study will reveal CTA combined with digital technology in the vascular anatomy of the anterior external femoral flap and the design of the flap before and during surgery, so as to provide help for the repair of tissue defects.

Trial registration:

It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000038951), Registered on October 10th, 2020.
Barriers and facilitators to exercise in hemodialysis patients
Authors: Li Tianzi , Lv Aili , Xu Na , Huang Mei , Su Yan
Published: December 2020

Background:

Exercise training has a lot of potential benefits for hemodialysis patients. And some guidelines emphasize the importance of exercise for maintenance hemodialysis. However, there are many barriers to encourage hemodialysis patients to increase their level of physical activity. A broader understanding of the specific barriers is needed.

Methods:

MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, PubMed, CBM, CNKI, and WangFang will be searched electronically. The Reference lists of included studies will be retrieved manually. If the study is designed with qualitative or mixed methods and directly explores the factors related to the exercise of dialysis patients, the study will be selected. The Critical Appraisal Skills Programme Qualitative Checklist will be applied for the study appraisal. The study search, selection and evaluation of the study will be conducted by 2 independent reviewers. Thematic synthesis will be used for synthesizing the findings of the primary studies.

Results:

This study will provide a high-quality synthesis to examine the barriers and facilitators affecting exercise in hemodialysis patients from the perspective of patients, caregivers, and health care providers.

Conclusion:

This systematic review will contribute to the in-depth understanding of barriers and facilitators affecting exercise in hemodialysis patients, and improve the prognosis of this population.

Ethic and dissemination:

The content of this article does not involve moral approval or ethical review because no individual data will be collected.

PROSPERO registration:

CRD42020200278. (https://www.crd.york.ac.uk/prospero/#recordDetails).
Efficacy and safety of Xuefu Zhuyu decoction combined with Western medicine for angina pectoris in coronary heart disease
Authors: Wang Duode , Wang Ping , Zhang Rong , Xi Xiaoping
Published: December 2020

Background:

Angina pectoris in coronary heart disease (CHD) is a common ischemic heart disease clinically. During the onset, patients often have symptoms such as chest discomfort or paroxysmal crushing pain in the posterior sternum, which seriously affects the quality of life of patients, and even can lead to myocardial infarction and endanger the lives of patients. Clinical studies have shown that the compound Chinese prescription Xuefu Zhuyu decoction combined with western medicine has a certain therapeutic effect on angina pectoris in CHD, but lack of evidence of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD.

Methods:

Use computer to retrieve English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wan Fang, VIP, Chinese biomedical database), from the establishment of database to October 2020, for randomized controlled trials (RCTs) of Xuefu Zhuyu decoction combined with Western medicine for angina pectoris in CHD. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literatures.

Results:

The efficacy and safety of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD were evaluated by total effective rate, angina pectoris pain score, TCM syndrome score, electrocardiogram effect, hemorheology index (including whole blood viscosity, plasma viscosity, hematocrit, and fibrinogen), and the incidence of adverse reactions.

Conclusion:

This study will provide reliable evidence-based evidence for the clinical application of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD.

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF Registration number:

DOI 10.17605 / OSF.IO / GFEQ7.
A randomized, double-blind, placebo-controlled, multicenter clinical trial for efficacy and safety of traditional Chinese medicine combined with antibiotics in the treatment of bacterial pneumonia in children
Authors: Wei Lina , Guo Yina , Fei Yutong , Luo Lin , Wang Caiwen , Wang Xuejiao , Sun Haihang , Liu Liang , Han Jing , Ren Xiaoting , Yao Bo , Wang Lei , Wang Yijie , Sun Liping
Published: December 2020

Background:

Pneumonia is the second leading cause of death in children worldwide after preterm birth and certification. Bacteria, viruses, mycoplasma, and other microorganisms are known to be the main causes of pneumonia, of which bacterial pathogenic factors account for 12.5% of cases. The invention and application of antibiotics have improved the prognosis of children with community-acquired bacterial pneumonia (CABP) to a certain extent, but with the emergence of antibiotic resistance worldwide, the mortality of children with CABP is still high. “Maxing Shigan Decoction” and “Qingfei Decoction” have significant efficacy in the treatment of CABP in children, but there is no standardized randomized controlled trial to systematically evaluate the outcomes.

Methods:

This study is a randomized, double-blind, placebo-controlled, multicenter clinical trial that will randomize 240 patients with CABP to group of Oral Maxing Shigan Decoction, group of Qingfei Decoction or group of placebos administered 3 times a day for 7 days. This study will observe a wide range of clinically relevant endpoints that have been used in clinical trials of pneumonia, including but not limited to clinical cure rate, antibiotic application days, complete antipyretic rate, complete antipyretic days, disease efficacy, traditional Chinese medicine syndrome effect, and antibiotic upgrade treatment rates. Safety will be assessed by monitoring for the incidence of adverse events during the study.

Discussion:

This clinical trial is the first to evaluate the efficacy and safety of “Maxing Shigan Decoction” and “Qingfei Decoction” in the treatment of children with CABP. The research results will provide a reference for future research design.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR1900025354. Registered on 14th October 2019-Retrospectively registered, http://www.chictr.org.cn/.
Efficacy and safety of micro-implant anchorage in Angle class II malocclusion orthodontic treatment
Authors: Wang Kaiting , Fan Hongliang , Yang Hongmei , Li Jianbin , Xie Weihong
Published: December 2020

Background:

Angle class II malocclusion is clinically complex and common malocclusion type, which affects beauty. Conventional treatment has the disadvantages of long course of treatment, high cost, easy recurrence and limited curative effect. Clinical practice shows that micro-implant anchorage has certain advantages in the treatment of Angle II malocclusion, but lacks the evidence of evidence-based medicine. This study systematically evaluates the efficacy and safety of micro-implant anchorage in the treatment of Angle class II malocclusion.

Methods:

A systematic search was performed by retrieving on English databases (PubMed, Embase, Web of Science, and the Cochrane Library) and Chinese databases (CNKI, Wanfang, Weipu [VIP], CBM). Besides, manually search for Google and Baidu academic of micro-implant anchorage in the treatment of Angle class II malocclusion in randomized controlled clinical research. The retrieval time limit was from the establishment of the database to September 2020. Two researchers independently extracted and evaluated the quality of the data in the included study. A meta-analysis was performed using RevMan5.3 software.

Results:

In this study, the efficacy and safety of micro-implant anchorage against Angle class II malocclusion were evaluated by SNA, BNA, ANB, NLA°, Adverse reaction.

Conclusions:

This study will provide reliable evidence-based evidence for the clinical application of micro-implant anchorage in the treatment of Angle class II malocclusion.

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF Registration number:DOI 10.17605/OSF.IO/UPBR8.
The mediating and moderating roles of resilience in the relationship between anxiety, depression, and post-traumatic growth among breast cancer patients based on structural equation modeling
Authors: Li Linbo , Hou Yongchao , Kang Fengying , Wei Xueliang
Published: December 2020

This study aimed to analyze the moderation and moderation effects of resilience on the anxiety, depression impact on post-traumatic growth (PTG) among breast cancer patients undergoing chemotherapy based on structural equation modeling, and confirmed whether resilience was a mediating and regulating variable between anxiety, depression, and post-traumatic growth. In addition, whether anxiety and depression have different effects on PTG under different levels of psychological resilience.

This cross-sectional study was conducted from November 2017 to January 2019, with subjects of 260 breast cancer patients undergoing chemotherapy in the department of breast and general surgery of a tertiary general hospital in Shanxi Province of China.

Data were collected according to the General Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and the posttraumatic growth inventory. Estimated values of model path coefficients and significance test were performed to confirm the mediation effect. Hierarchical regression and simple slope test were used to analyze the regulation effect.

Resilience showed significant correlations with anxiety, depression and PTG (all P < .01). Estimated values of model path coefficients and significance test results indicated that the mediating role of resilience was remarkable and it could regulate anxiety, depression, and PTG.

The anxiety, depression and resilience affected their PTG of breast cancer patients during chemotherapy, suggesting the need to establish a cooperative mechanism based on the concept of multidisciplinary collaboration. Professional psychological intervention should be used to reduce anxiety and depression and to explore the potential of resilience to promote their PTG.
Efficacy and safety of laser therapy for the treatment of retinopathy of prematurity
Authors: Wang Fei , Hao Li-xia
Published: December 2020

Background:

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. Although a variety of managements are available for ROP, the efficacy is still unsatisfied. Studies have suggested that laser therapy (LT) may benefit ROP. However, no systematic review has addressed this topic. Thus, this systematic review aims to evaluate the efficacy and safety of LT for ROP.

Methods:

A comprehensive literature search will be performed from electronic databases (PubMed, EMBASE, AMED, Cochrane Library, WorldSciNet, Science online, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure) and other sources. The time is from the database construction to the present. Two investigators will independently carry out literature selection, data extraction and quality assessment. We will utilize RevMan 5.3 software for statistical analysis. Data synthesis will be conducted either as a narrative summary or meta-analysis. Statistical heterogeneity will be appraised using I

2
test. If heterogeneity is low, pooled estimates will be calculated using a fixed-effects model. Otherwise, we will utilize a random-effects model to pool the data.

Results:

This study will provide up-to-date evidence on the efficacy and safety of LT for ROP, which may help to assess whether LT is effective and safe for ROP.

Conclusion:

This study will provide helpful evidence to determine whether or not LT is effective and safe for ROP, which may benefit both patients and clinicians.

Study registration:

osf.io/3tmnf.
Cross-sectional study of diabetes kidney disease in the Eastern Cape, South Africa
Authors: Adeniyi Oladele Vincent , Owolabi Eyitayo Omolara
Published: December 2020

Diabetes mellitus (DM) is an independent risk factor for the development of kidney disease. This study assesses the prevalence and determinants of asymptomatic kidney disease in individuals with DM attending health facilities in OR Tambo district, Eastern Cape, South Africa.

In this cross-sectional analysis, medical data of 327 individuals receiving care for DM in primary health care centers in OR Tambo district, Eastern Cape between June and November 2013 were reviewed. Significant kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m2 in accordance with the guidelines of the Society of Endocrinology, Metabolism and Diabetes of South Africa (2017).

One-quarter of the 327 participants (n = 80) had significant kidney disease. Female sex [odds ratio (OR) = 5.2; 95% confidence interval (95% CI) 1.2–23.5], never used alcohol (OR = 13.4; 95% CI 2.5–72.1), hypertension (OR = 16.2; 95% CI 2.0–130.0), triglyceride (TG)/high-density lipoprotein (HDL) ratio (OR = 1.2; 95% CI 1.0–1.5), current smoker (OR = 1127.9; 95% CI 162.9–7808.9), former smoker (OR = 13.3; 95% CI 4.1–41.4), and longer duration of diabetes (OR = 4.6; 95% CI 1.6–13.0) were the independent determinants of significant kidney disease among the participants. A significant dose--effect relationship exists between renal disease and smoking status (P < .0001), duration of DM (P < .001), glycemic status (P = .025), and body mass index (P = .003).

There is a high rate of undiagnosed kidney disease in this setting, which was independently associated with female sex and presence of other cardiovascular risk factors. Strategic interventions targeting screening and monitoring of renal functions in individuals with DM are urgently needed in this region.