bluuebunny/crossref_metadata_2025 huggingface dataset:
Past Asbestos Exposure in Rolling Stock Manufacturing in the Absence of Environmental Monitoring: An Original Method
Authors: Silvestri Stefano , Ciapini Cesare , Innocenti Andrea
Published: August 2022

Objective

The aim of this study is the reconstruction of asbestos exposure in absence of environmental monitoring data, to use the results in a cohort study of railway rolling stock workers.

Methods

To reconstruct past exposures, the production data (number of rolling stock and asbestos content) and working methods were reconstructed with former employees and company documentation, literature data, and author expertise.

Results

The result of the work is a job/exposure matrix from 1956 to 1979, when sprayed asbestos was used as insulator of the metal bodies. Annual exposure estimate varies from 0.08 to 4.9 fb/mL depending on the specific jobs. Thirty-one mesotheliomas with occupational exposure, one with environmental and one with family exposures, were identified.

Conclusions

The originality of the study consists on the use of company production data to establish frequency duration of asbestos exposure.
Cardiorespiratory Fitness Is Inversely Associated With Aortic Arterial Stiffness in Firefighters
Authors: Nagel Tom R. , Melton Bridget F. , Keeler Jason M. , Cross Brett L. , Blumenburg Wesley T. , Flatt Andrew A. , Stoner Lee , Grosicki Gregory J.
Published: August 2022

Objectives

The aim of this study was to determine whether cardiorespiratory fitness (CRF), expressed as VO2max (mL/kg/min), is associated with resting AS (carotid-femoral pulse wave velocity [cf-PWV]) and the AS response to simulated fire suppression activities in firefighters.

Methods

In firefighters (n = 20, 34 ± 8 years), AS was determined using cf-PWV (m/s) before and after a fire simulation exercise. VO2max was determined using a standard treadmill protocol. Linear regression models, adjusted for body fat percentage, are reported as unstandardized (b) and standardized (β) betas (effect sizes).

Results

H1: there was a moderate (ie, β = 0.5–0.8), inverse association between cf-PWV and VO2max (b = −0.80; 95% confidence interval [CI], −0.14 to −0.02; β = 0.71). H2: there was a moderate, positive association between ∆cf-PWV and VO2max (b = 0.05; 95% CI, 0.00–0.10; β = 0.62).

Conclusions

These findings indicate that CRF may protect against arterial stiffening in firefighters.
Low-Dose Occupational Exposure to Nickel and Thyroid Hormones
Authors: Monti Carlo , Giammichele Grazia , Antuono Vittorio , Loreti Beatrice , Tomei Francesco , De Marco Federica , Massimi Roberto , Marchione Stefania , Suppi Anastasia , Tomei Gianfranco , Ricci Serafino
Published: August 2022

Introduction

The aim of this study was to evaluate the effects of a low-dose exposure to nickel, as it is present in urban air, on thyroid hormones and on thyrotropin in outdoor workers exposed to urban pollutants.

Materials and Methods

A total of 164 outdoor workers were studied and divided by sex and smoking habit. Each worker underwent measurement of urinary nickel and of blood triiodothyronine, L-thyroxine, and thyrotropin levels. The statistical analysis was performed.

Results

Statistical analysis shows a significant and positive correlation between urinary nickel and L-thyroxine, both in total sample and in males.

Discussion and Conclusion

The study suggests that occupational exposure to a low dose of nickel may affect thyroid function in municipal police workers. These data may provide information on other categories of outdoor workers with similar exposure.
Antimicrobial stewardship
Authors: Lanckohr Christian , Bracht Hendrik
Published: August 2022

Purpose of review

The optimal use of antimicrobials is necessary to slow resistance development and improve patient outcomes. Antimicrobial stewardship (AMS) is a bundle of interventions aimed at promoting the responsible use of antiinfectives. The ICU is an important field of activity for AMS because of high rates of antimicrobial use, high prevalence of resistant pathogens and complex pharmacology. This review discusses aims and interventions of AMS with special emphasis on the ICU.

Recent findings

AMS-interventions can improve the quality and quantity of antimicrobial prescribing in the ICU without compromising patient outcomes. The de-escalation of empiric therapy according to microbiology results and the limitation of treatment duration are important steps to reduce resistance pressure. Owing to the complex nature of critical illness, the pharmacological optimization of antimicrobial therapy is an important goal in the ICU. AMS-objectives and strategies are also applicable to patients with sepsis. This is reflected in the most recent guidelines by the Surviving Sepsis Campaign. AMS-interventions need to be adapted to their respective setting and be mindful of local prescribing cultures and prescribers’ attitudes.

AMS in the ICU is effective and safe. Intensivists should be actively involved in AMS-programs and propagate responsible use of antimicrobials.
Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson’s disease
Authors: Kashif Muhammad , Ahmad Ashfaq , Bandpei Muhammad Ali Mohseni , Farooq Maryam , Iram Humaira , e Fatima Rida
Published: August 2022

Background:

Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson’s (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients.

Methods:

A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors.

Results:

Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD.

Conclusion:

This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.
Posterior temporary fixation of C1–C2 screw-rod system for unstable C1 burst fracture
Authors: Chen Yun-lin , Hu Xu-dong , Wang Yang , Jiang Wei-yu , Ma Wei-hu
Published: August 2022

Whether an unstable C1 burst fracture should be treated surgically or conservatively is controversial. The purpose of this study is to evaluate the effectiveness and motion-preserving function of temporary fixation of C1–C2 screw-rod system for the reduction and fixation of unstable C1 burst fracture.

We retrospectively reviewed 10 patients who were treated with posterior C1–C2 temporary fixation without fusion. We assessed age at surgery, gender, pre- and postoperative visual analog scale (VAS), Neck Disability Index (NDI), atlanto-dens interval (ADI), lateral mass distance (LMD), and rotation function of C1–C2 complex.

Six males and 4 females were included in our study. The average follow-up duration was 14.1 ± 1.37 months. The left-to-right ROMs of C1–C2 rotation was 9.6° ± 1.42°. The preoperative cervical VAS was 8.30 ± 0.48; the postoperative cervical VAS of C1–C2 fusion was 2.90 ± 0.57. The preoperative VAS for removal was 2.0 ± 0.00, and the postoperative VAS for removal was 2.3 ± 0.48. The preoperative cervical NDI was 81.40% ± 2.07%, the postoperative cervical NDI of C1–C2 fusion was 18.10% ± 1.52%. The preoperative NDI for removal was 15.9% ± 1.20%. The postoperative NDI for removal was 14.5% ± 1.08%. The preoperative ADI was 4.43 ± 0.34 mm, and postoperative ADI was 1.94 ± 0.72 mm. The preoperative LMD was 6.36 ± 0.58 mm, and postoperative LMD was 1.64 ± 0.31 mm.

Posterior temporary C1–C2 fixation can achieve a good fusion and satisfied reduction of C1 fracture, relieve the pain, improve the cervical function outcome, but may reduce the rotational range of motion of C1–C2. Posterior C1–C2 temporary fixation without fusion was not suitable for C1 burst fracture. We recommend permanent C1–C2 fixation and fusion for C1 burst fracture if surgery is necessary.
Emerging trends in sacubitril/valsartan research: A bibliometric analysis of the years 1995–2021
Authors: Lai Ping , Xue Jin-Hua , Xie Mu-Jin , Ye Jin-Hua , Tian Ke-Jun , Ling Jia-Yuan , Zhong Wen-Ting , Chen Dong , Zhong Yi-Ming , Liao Yong-Ling
Published: August 2022

Background:

Sacubitril/valsartan has been approved for the treatment of heart failure (HF) patients with reduced ejection fraction; since then, it gradually became a new star drug in the therapy of HF. Nevertheless, the effectiveness of sacubitril/valsartan remains under investigation. Thus far, only a few bibliometric studies have systematically analyzed the application of sacubitril/valsartan.

Methods:

Publications on sacubitril/valsartan were retrieved from the Web of Science Core Collection on April 29, 2021. Data were analyzed using Microsoft Excel 2019 (Redmond, WA), VOS viewer (Redmond, WA), and Cite Space V (Drexel University, Philadelphia, PA).

Results:

A total of 1309 publications on sacubitril/valsartan published from 1995 to 2021 were retrieved. The number of publications regarding sacubitril/valsartan increased sharply in the last 6 years (2015–2021), and American scholars authored >40% of those publications. Most were published in the European Journal of Heart Failure, the United States was the bellwether with a solid academic reputation in this area. Solomon published the highest number of related articles and was the most frequently cited author. “Heart failure” was the leading research hotspot. The keywords, “inflammation,” “fibrosis,” and “oxidative stress” appeared most recently as research fronts.

Conclusions:

Research attention should be focused on clinical trial outcomes. Considering its effectiveness in HF, the mechanisms and further applications of sacubitril/valsartan may become research hotspots in the future and should be closely examined.
Mapping the global literature output on nocturia: A bibliometric and visualized analysis
Authors: Ahmad Tauseef , Khan Muhammad , Al-Omari Basem
Published: August 2022

Purpose:

This study aims to facilitate researchers’ and clinicians’ understanding of research frontiers and trends in nocturia. It explores the scientific research outcomes and key bibliometric indices and plots global research on nocturia.

Methods:

A bibliometric retrospective study was designed, and an online search was conducted in the Web of Science Core Collection database using the potential search keywords related to nocturia in the title field with some specific filtration. HistCite™ and VOSviewer software for windows were used to analyze the data obtained for authors, journals, countries, institutions, keywords, and visualization mapping.

Results:

The initial search retrieved 1479 hits. A total of 1445 publications were included in the final analysis. Of these, 43.53% were published as articles. The most studied area in nocturia is urology nephrology. The most productive year was 2019 (n = 121, citations = 335), and the most prolific author, both in terms of publications (n = 97) and citations (1658) was Weiss JP. The most cited journal in nocturia research was the Journal of Urology (n = 293, citations = 3050). The most widely used keyword in nocturia publications was nocturia (n = 1249). Visualization mapping shows that the USA was the most influential and highly cited country in nocturia research.

Conclusion:

This study showed that there has been an increasing research trend in nocturia over the past few years. The current findings provide important empirical evidence for researchers, clinicians, and physicians to understand research frontiers and trends, achievements, collaborative networks, and hotspot research topics in the research field of nocturia.
Immune-checkpoint inhibitor-associated grade 3 hepatotoxicity managed with enteric-coated budesonide monotherapy: A case report
Authors: Eleftheriotis Gerasimos , Skopelitis Elias
Published: August 2022

Rationale:

The introduction of immune-checkpoint inhibitors (ICPI) in recent years has changed the natural course of many neoplasms. However, patients receiving these medications may present immune-mediated adverse events; management includes temporary or permanent cessation of treatment and corticosteroids, occasionally combined with other immunomodulators. Such immunosuppression, however, also has numerous adverse events and even if it is effective in controlling toxicity, it delays immunotherapy reinitiation, as current evidence requires dose tapering to ≤10 mg prednisolone equivalent before rechallenge. Enteric-coated budesonide is a corticosteroid formulation acting primarily to the intestine and liver, as a result of its extensive first-pass hepatic metabolism.

Patient concerns:

A 76-year-old woman treated with ipilimumab for metastatic melanoma presented with abdominal pain, vomiting, and diarrhea for at least the previous 4 days. Laboratory tests, among others, revealed elevated aminotransferases and C-reactive protein. During hospitalization, the patient also developed fever.

Diagnosis:

The patient, after excluding alternative causes of aminotransferase elevation, was diagnosed with grade 3 ipilimumab-associated hepatotoxicity.

Interventions:

Budesonide monotherapy was administered; initial daily dose was 12 mg.

Outcomes:

Fever subsided after the first dose of budesonide. Aminotransferases returned to normal-near normal approximately 1 month after the first dose of budesonide. After this point, daily dose was reduced by 3 mg every 2 weeks, with no clinical or biochemical relapse.

Conclusions:

This case of ICPI hepatitis is, to our knowledge, the first in the literature managed with budesonide monotherapy. Therefore, budesonide may be a potentially attractive option for the management of ICPI-associated liver injury in cases where corticosteroid treatment is necessary due to its safety profile and the potential advantage of faster immunotherapy rechallenge in selected patients without requiring dose tapering, in contrast to systemically acting corticosteroids. Clinical trials should be conducted in the future in order to validate or refute these findings.
Utilizing timed categorical recall (naming US cities) for rapid bedside dementia screening
Authors: Joseph Charles R. , Cargill Michael P. , Lee Chansoon D.
Published: August 2022

The availability of fast validated screening for dementia is a critical clinical need to improve neurologic examination time efficiency. This study validated a 1-minute timed categorical recall (TCR) method, naming as many US cities as possible and compared TCR to the Folstein Minimental Status Exam (MMSE) as a preliminary cognitive screening tool.

Random uncompensated 349 volunteers were recruited ages 18 to 97 from local free clinics, retirement homes, university faculty, and students in Lynchburg, Virginia 2015 to 2020. Participants’ demographic and medical information were collected. After 1 minute preparation, participants were rapidly named as many US cities as possible until they were told to stop (1 minute). The time limitation was withheld in advance. Number of cities and organizational strategies were recorded. Folstein MMSE administration immediately after TCR was administered to 122 subjects recruited in the final 2 study years as a comparison benchmark. A multiple linear regression model and a regression tree model were used to identify important variables for the number of cities named and determine subgroups and their thresholds.

TCR resulted in accuracy rate (0.80), sensitivity (0.78), and specificity (0.81). The global TCR threshold (9 cities named) is superseded by 4 subgroup thresholds, categorized by statistically important variables (age, education level, and number of states visited) as follows:

For those visiting ≥8 states and

1. 18 to 71 ages with a master’s degree or above, the threshold was naming 20 cities;

2. 18 to 29 ages with a bachelor’s degree or below, the threshold was naming 17 cities;

3. 30 to 71 ages with a bachelor’s degree or below, the threshold was naming 10 cities.

For those visiting <8 states or for ages 72 to 97 (regardless of education levels and number of states visited), the threshold was naming 8 cities.

American cities are common knowledge across ages and backgrounds, making it a useful bedside screen for dementia. In clinical practice, patients who report fewer cities than the threshold of 9 cities should receive further cognitive testing. If the patient meets the criteria for a subgroup, then the higher subgroup thresholds apply. TCR is a more time-efficient preliminary dementia screening tool with improved sensitivity and similar specificity compared with MMSE.
Bipolar type I diagnosis after a manic episode secondary to SARS-CoV-2 infection: A case report
Authors: D’Imperio Ambra , Lo Jonathan , Bettini Luca , Prada Paco , Bondolfi Guido
Published: August 2022

Rationale:

Our objective is to provide awareness about psychotic vulnerability in patients infected with SARS-CoV-2 and to better understand the role of steroid withdrawal in manic episodes, especially with its common usage in respiratory disease caused by SARS-CoV-2.

Patient concerns:

We present the case of a patient who was hospitalized twice after discontinuing steroid therapy for SARS-CoV-2 infection and presented with a manic episode despite not having a psychiatric history.

Diagnosis:

The patient tested positive on a polymerase chain reaction test for SARS-CoV-2 and developed pneumonia. Other organic differential diagnoses such as encephalitis were also investigated and excluded. Manic episodes were diagnosed according to DSM-V criteria. Subsequently, the patient was diagnosed with type I bipolar disorder.

Interventions:

According to the protocols, supplemental oxygen therapy, prophylactic enoxaparin and intravenous (IV) steroids were administered. Steroid dosage was gradually reduced under supervision. During the acute mania, antipsychotics and benzodiazepines were administered.

Outcomes:

After discharge, the patient was admitted to the psychiatric consultation service. He first received mood stabilizer therapy and then received supportive psychotherapy.

Lessons:

Psychotic symptoms commonly occur after the discontinuation of high-dose steroid therapy; however, controlled tapering may prevent these side effects. Only a few cases have reported concomitant SARS-CoV-2 infection and manic episodes, often with an apparent relationship with steroid withdrawal syndrome. In this case, we considered psychotic vulnerability a condition that is often underestimated. In consideration of the SARS-CoV-2 pandemic, the case may represent an underlying trigger for psychotic decompensation, which, in concert with neuroinflammation, may induce a manic episode.
Rare case of upper gastrointestinal hemorrhage due to accessory spleen: A case report
Authors: Liu Yuanjun , Dai Yi , Xiao Fan , Liu Shuang , Wu Yakun , Ran Enrong
Published: August 2022

Rationale:

Upper gastrointestinal hemorrhage (UGIH) is defined as hemorrhage originating from the gastrointestinal tract proximal to the ligament of Treitz. The causes of UGIH include esophagitis, gastritis, peptic ulcers, Mallory–Weiss syndrome, and cancer. However, a rare cause of UGIH, such as an accessory spleen, may lead to serious complications if left untreated and can sometimes be very difficult to diagnose preoperatively.

Patient concerns:

An 18-year-old man was admitted to the Department of Gastroenterology of our hospital due to “repeated black stool for 2 months with aggravation, accompanied by hematemesis for 9 days.” He denied any history of hepatitis, trauma, or surgery.

Diagnosis:

Laboratory evaluation revealed severe anemia (hemoglobin, 6.4 g/dL). Computed tomography revealed a mass measuring 127 mm in its largest dimension, located in the upper left abdomen, with varicose veins in the gastric fundus. Moreover, distended blue–purple tortuous veins were observed by gastroscopy in the gastric fundus. We believed the mass was likely an abnormally proliferating accessory spleen; however, the causes of severe anemia and gastrointestinal hemorrhage were unknown.

Interventions:

After discussion in a multidisciplinary conference, the mass was completely resected laparoscopically, and the subserosal veins in the gastric fundus were sutured using absorbable threads.

Outcomes:

After the surgery, the patient recovered uneventfully without any complications. Clinicopathological examination showed that the mass was chronic congestive splenomegaly. Gastrointestinal hemorrhage secondary to an abnormally proliferating accessory spleen was confirmed as the diagnosis. Laboratory evaluation revealed hemoglobin at 12.1 g/dL 2 months after surgery. At the 12-month follow-up, the patient showed no recurrence of gastrointestinal hemorrhage.

Lessons:

UGIH caused by accessory spleen is extremely rare. This entity should be considered in differential diagnosis of gastrointestinal hemorrhage. Surgical intervention is necessary for timely diagnosis and treatment in case of gastrointestinal hemorrhage in critical clinical situations.
Effects of magnesium valproate adjuvant therapy on patients with dementia: A systematic review and meta-analysis
Authors: Zhang ChenQi , Sun LingQi , Sun HongBin
Published: August 2022

Background:

Current research has found contradictory results on the treatment of magnesium valproate (VPM) in patients with dementia (PwD).

Objectives:

Here, we conducted a meta-analysis to evaluate the efficacy and safety of VPM in the adjuvant treatment of PwD.

Purpose:

Current research has found contradictory results on the treatment of VPM in PwD. Here, we conducted a meta-analysis to evaluate the efficacy and safety of VPM in the adjuvant treatment of PwD.

Methods:

MEDLINE via PubMed, Cochrane Library, EBSCO, Embase, China National Knowledge (CNKI), and Wan Fang databases were researched to gather relevant data on magnesium valproate assistant therapy for patients with dementia (PwD) by using medical subject headings and term words.

Results:

After the final screening, 22 RCT studies (a total of 1899 participants) were included in this meta-analysis, which compared VPM adjuvant treatment with antidementia or psychotropic drug monotherapy. Significant differences were found in the scores on mini-mental state examination (P = .028), Alzheimer disease assessment scale cognitive subscale (P < .05), Bech-Rafaelsen Mania Rating Scale (P < .05), behavioral pathology in Alzheimer disease rating scale (P = .001), activities of daily living (P < .05), and Pittsburgh Sleep Quality Index (P < .05). Besides, the levels of inflammatory factors including IL-1β, IL-6, and TNF-α were significantly lower than those in the monotherapy group (P < .05). While there was no increase in the incidence of adverse events (P = .383), VPM as an assistant therapy is generally well tolerated in PwD.

Conclusion:

By meta-analysis, evidence was found to support VPM additional used for the treatment of cognitive function, psychiatric symptoms, or disease improvement in PwD. VPM may be a potential drug to aid in the treatment of dementia patients. However, there was lack of enough evidence to classification of dementia severity in our inclusion study. More research is still needed, including clinical trials evaluating VPM as a complementary therapy.
Small bowel perforation caused by thermal injury during colonic polypectomy: A case report and literature review
Authors: Yuan Cong , Xu Kui , Yang Guo-Dong , Xi Chun-Hui , Lin Xue-Mei
Published: August 2022

Rationale:

Iatrogenic gastrointestinal perforation is a known uncommon complication of colonoscopy. The perforation usually occurs in the colon itself. Rarely, colonoscopic procedures can also cause the perforations of the small intestine.

Patient concerns and diagnoses:

We describe the case of a 70-year-old man who experienced abdominal pain several hours after electrical polypectomy in the transverse colon. Urgent abdominal computed tomography scans showed a few bubbles on the frontal surface around the liver and a little extraluminal free air in the upper abdomen. Urgent exploratory laparotomy revealed a round perforation with a diameter of approximately 5 mm in the ileum 80 cm proximal to the ileocecal valve, accompanied by the outflow of intestinal contents. A small bowel perforation by thermal injury was diagnosed during colonic polypectomy.

Interventions and outcomes:

The ileal perforation was repaired primarily after debridement of the perforation site and abdominal cavity. The patient recovered well after surgery. Histopathological examination of the perforation site demonstrated inflammatory necrosis and infiltration of inflammatory cells.

Lessons:

Small bowel perforation should be considered after colonoscopic procedures although the incidence is exceedingly rare. Urgent exploratory laparotomy is warranted when a visceral perforation is identified after colonoscopy.
Convalescent plasma therapy for patients with severe COVID-19: A case series study
Authors: Huang Jinbao , Weng Heng , Lan Changqing , Li Hongyan
Published: August 2022

Coronavirus disease 2019 (COVID-19) is a novel acute respiratory infectious disease that can lead to multiple-organ dysfunction in patients with severe disease. However, there is a lack of effective antiviral drugs for COVID-19. Herein, we investigated the efficacy and safety of convalescent plasma (CP) therapy for treating severe COVID-19 in an attempt to explore new therapeutic methods.

The clinical data of 3 imported patients with severe COVID-19 who underwent treatment with CP and who were quarantined and treated in a designated COVID-19 hospital from March 2020 to April 2020 were collected and analyzed.

The 3 patients, including a 57-year-old male, 65-year-old female, and 59-year-old female, were clinically classified as having severe COVID-19. The main underlying diseases included hypertension, diabetes, sequelae of cerebral infarction, and postoperative thyroid adenoma. The common symptoms included cough, fever, and shortness of breath. All patients received antiviral drugs and other supportive treatments. Additionally, CP treatment was administered. At 48 to 72 hours after the CP transfusion, all 3 of the patients exhibited an improvement and alleviation of symptoms, an elevated arterial oxygen saturation, and decreased C-reactive protein and interleukin-6 levels. The counts of the total lymphocytes and T lymphocytes (CD3+) and their subsets (CD4 + and CD8+) were also obviously increased. Repeated chest computed tomography also revealed obvious absorption of the lesions in the bilateral lungs. Only 1 patient had a mild allergic reaction during the CP infusion, but no severe adverse reactions were observed.

The early treatment with CP in patients with severe COVID-19 can rapidly improve the condition of the patients, and CP therapy is generally effective and safe.
Single-dose prophylactic ibuprofen therapy for patent ductus arteriosus in preterm infants
Authors: Kim Chae Young , Chung Sung-Hoon
Published: August 2022

This study aimed to evaluate the short-term morbidities and efficacy of single-dose prophylactic intravenous ibuprofen for patent ductus arteriosus (PDA) on the first day of life in preterm infants.

Data of 69 preterm infants with birth weight < 1250 g and gestational age < 30 weeks admitted to the neonatal intensive care unit were analyzed. Of these, 37 infants were assigned to the prophylactic treatment (PT) group and 32 were assigned to the nonprophylactic treatment (non-PT) group. Only the PT group administered intravenous ibuprofen (10 mg/kg) once within 6 hours after birth.

Until postnatal day 7, ductal closure occurred in 11 (34.4%) infants in the non-PT group, and in 35 (94.6%) infants in the PT group, of which 30 (81.1%) infants had ductal closure on postnatal day 1. There were 2 (5.4%) infants in the PT group and 9 (28.1%) in the non-PT group who needed ibuprofen treatment due to moderate-to-large PDA after postnatal day 7. Preterm infants in the PT group were less likely to develop an intraventricular hemorrhage (≥grade 2) (adjusted odds ratio 0.007, 95% confidence interval 0.01–0.45), had a shorter duration of invasive ventilatory support and central venous catheter, and earlier postnatal age to achieve feeding of 50 and 100 mL/kg/day compared with those in the non-PT group.

Single-dose prophylactic intravenous ibuprofen on the first day of life decreased the occurrence of a persistent PDA and intraventricular hemorrhage (≥grade 2), and reduced the duration of invasive ventilatory support, central venous catheter use, and hospital stay.
STROBE-GnRHa pretreatment in frozen-embryo transfer cycles improves clinical outcomes for patients with persistent thin endometrium: A case-control study
Authors: Liu Yixuan , Ma Lijuan , Zhu Min , Yin Huirong , Yan Hongli , Shi Minfeng
Published: August 2022

The well-prepared endometrium with appropriate thickness plays a critical role in successful embryo implantation. The thin endometrium is the main factor of frozen-embryo transfer (FET), resulting in the failure of implantation undergoing FET. Hormone treatment is suggested to improve endometrium thickness; however, among the larger numbers of cases, it cannot reach the sufficient thickness, which leads to a high cancelation rate of embryo transfer as well as waste high-quality embryos. Thus, it increases the burden to patients in both economic and psychological perspectives. We performed a retrospective observational study, which was composed with 2 cohorts, either with the conventional hormone replacement therapy (HRT) protocol or HRT with gonadotrophin-releasing hormone agonist (GnRHa) pretreatment to prepare the endometrium before FET. The measurements of endometrium thickness, hormone level, transfer cycle cancelation rate, pregnancy rate, and implantation rate were retrieved from the medical records during the routine clinic visits until 1 month after embryo transfer. The comparisons between 2 cohorts were performed by t-test or Mann–Whitney U test depending on the different attributions of data. In total, 49 cycles were under HRT with GnRHa pretreatment and 84 cycles were under the conventional HRT protocol. HRT with GnRHa pretreatment group improved the endometrial thickness (8.13 ± 1.79 vs 7.51 ± 1.45, P = .031), decreased the transfer cancelation rate (P = .003), and increased clinical pregnancy rate and implantation rate significantly (both P = .001). Additionally, luteinizing hormone level in pretreatment group was consistently lower than conventional HRT group (P < .05). Our study revealed HRT with GnRHa pretreatment efficiently improved the endometrial thickness, therefore, decreased the FET cycle cancelation. It also elevated the embryo implantation rate and clinical pregnancy rate by improving endometrial receptivity.
Study on screening and evaluation methods of cosmetics for people with facial sensitive skin
Authors: Lyu Jing , Diao Qing-chun , Wang Sha , Yu Yin , Jiang Yang
Published: August 2022

Objective:

The purpose of this study is to screen and evaluate cosmetic products for sensitive skin on the face.

Methods:

Thirty-five subjects with positive lactic acid sting test (LAST) were recruited from the staff of our hospital from November 2019 to February 2020. First, the human skin enclosed patch test of cosmetic gel (abbreviated as gel) was performed, and then the tested products were continuously applied for 4 weeks to complete the long-term efficacy test. Subjects’ sensation of application, pruritus, tingling and burning were assessed on a 0 to 9 scale prior to, 14, and 28 days after topical application. Moreover, the transepidermal water loss rate (TEWL), stratum corneum (SC) hydration, melanin index (MI), erythema index (EI) and dendritic cells and inflammatory cell infiltration were noninvasively detected by the tester. LAST were performed before applying, 14 and 28 days after application, and then the test results were compared.

Results:

In this study, a total of 34 people participated in the test. The results of human skin enclosed patch test indicated that only 1 case of grade 1 reaction occurred among the tested subjects. The subjects felt good after applying the products, and the gel showed high degree of skin comfortable, no irritation and good tolerability. Subjective safety evaluation illustrated that the scores of pruritus, tingling and burning of the subjects decreased in D14 and D28 patient revisit, showing statistically significant differences (P < .05). When the gel was applied for 4 weeks, TEWL (8.42 ± 1.12) and EI (201.35 ± 13.51) were lower than the results before application (P < .05), and the SC hydration (65.36 ± 2.56) was higher than that before application (P < .05). There was no correlation between the SC hydration and TEWL (R = 0.092, P = .416). The results of skin CT indicated that the number of facial dendritic cells decreased in 17 subjects (accounting for 50%) in D28 patient revisit, and the degree of inflammatory cell infiltration decreased in 27 subjects (accounting for 80%). Compared with the baseline value, the LAST score and total sensory score decreased after application the product for 4 weeks, and the difference was statistically significant (the mean value of P < .05).

Conclusion:

The subjective feeling of application and efficacy of cosmetics in people with sensitive skin could be successfully evaluated by the comprehensive application of human skin enclosed patch test, long-term trial test, subjective safety evaluation and objective efficacy evaluation. And it provides the basis to judge whether the cosmetic is consistent with the efficacy claim of sensitive skin.
Epidemiological characteristics and importance of lobulation of giant epidermal cysts: An 18-year retrospective review of 19 cases
Authors: Lee Kyu-Il , Namgoong Sik , You Hi-Jin , Jeon Tae-Sung
Published: August 2022

Giant epidermal cysts, which have a diameter of ≥5 cm, have rarely been reported. Giant epidermal cysts that have multiple lobules are referred to as multilocular giant epidermal cysts. This study aims to establish the epidemiological characteristics and statistically determine the significance of lobulation in giant epidermal cysts.

Data on 19 patients who developed giant epidermal cysts between January 2003 and February 2021 were retrospectively reviewed. Patients were divided into 2 groups based on the presence of septa and the differences in characteristics were analyzed.

Among the 19 patients, 16 (84.2%) were male, and the mean age was 57.7 ± 10.6 years. The mean patient-reported tumor duration was 14.8 ± 12.5 years. Seven (36.8%) patients had multilocular giant epidermal cysts, whereas 12 (63.2%) had unilocular giant epidermal cysts. Compared with unilocular giant epidermal cysts, multilocular giant epidermal cysts had a significantly larger mean diameter (6.0 ± 0.7 vs 8.2 ± 1.8 cm, P = .02) and estimated volume (91.8 ± 43.3 vs 250.0 ± 157.0 mL, P = .02).

Giant epidermal cysts have distinctive epidemiologic characteristics with predominance among males, those in their 50s, and a long tumor duration. Multilocular giant epidermal cysts are significantly larger in diameter and volume than unilocular ones.
A retrospective study on the clinical and pathological features of hepatic sarcomatoid carcinoma: Fourteen cases of a rare tumor
Authors: Ma Shuoshuo , Li Chunshuang , Ma Yang , Wang Xiaolei , Zhang Dengyong , Lu Zheng
Published: August 2022

Hepatic sarcomatoid carcinoma is a rare liver malignancy with atypical clinical symptoms and a high degree of malignancy. To improve the understanding of this disease, we collected the clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma admitted to the First Affiliated Hospital and Second Affiliated Hospital of Bengbu Medical College from 2011 to 2021 and reviewed the relevant literature.

The clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma were collected from the electronic medical record system of the 2 hospitals. All clinical data were independently reviewed by 2 clinicians, and all pathological data were independently reviewed by 2 pathologists. At the same time, we reviewed the related literature on hepatic sarcomatoid carcinoma in Pubmed and CNKI.

This group of 14 patients, 10 males and 4 females, aged 50–77 years. The main symptoms of the patients were abdominal pain, bloating, anorexia, fatigue or weight loss in the upper abdomen, and 3 patients were asymptomatic. On imaging, hepatic sarcomatoid carcinoma manifests as heterogeneous mass with irregular shape and unclear boundary, and computed tomography (CT)/magnetic resonance imaging (MRI) enhanced scan shows progressive or persistent heterogeneous enhancement, marginal enhancement or annular enhancement, and central necrosis. The pathological features of hepatic sarcomatoid carcinoma are the proliferation of spindle cells and pleomorphic cells, which alternate with acinar cells.

Hepatic sarcomatoid carcinoma is more common in middle-aged and elderly patients, especially men, and has no characteristic clinical manifestations. Imaging examination and B-ultrasound-guided liver biopsy + immunohistochemistry can help diagnose. Radical surgery is the preferred method for hepatic sarcomatoid carcinoma, and postoperative adjuvant chemotherapy is expected to prolong patient survival.
Risk factors associated with dysphagia after anterior surgery in treatment for multilevel cervical disorder with kyphosis
Authors: Li Yongjun , Wang Feng , Shen Yong
Published: August 2022

This is a retrospective study. Our aim was to investigate the risk factors related to dysphagia following anterior surgery treating the multilevel cervical disorder with kyphosis based on a subgroup of follow-up time. Finally, a total of 81 patients suffering from the multilevel cervical disorder with kyphosis following anterior surgery from July 2018 to June 2020 were included in our study. Patients with dysphagia were defined as the dysphagia group and without dysphagia as the no-dysphagia (NG) group based on a subgroup of follow-up time (1-week, 1-month, 3-month, 6-month, and 1-year after surgery). Clinical outcomes and radiological data were performed to compare between dysphagia group and NG. In our study, the rate of dysphagia was 67.9%, 44.4%, 34.6%, 25.9%, and 14.8% at 1-week, 1-month, 3-month, 6-month, and 1-year after surgery, respectively. Our findings showed that change of Cobb angle of C2–7 was associated with dysphagia within 3-month after surgery. Furthermore, postoperative Cobb angle of C2–7 was linked to dysphagia within 6-month after surgery. Interestingly, a history of smoking and lower preoperative SWAL-QOL score were found to be risk factors related with dysphagia at any follow-up. In the present study, many factors were found to be related to dysphagia within 3-month after surgery. Notably, a history of smoking and lower preoperative SWAL-QOL score were associated with dysphagia at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffering from dysphagia after anterior surgery in the treatment of multilevel cervical disorder with kyphosis.
A review of decision aids to assess cardiovascular risk
Authors: Westman Eric C.
Published: August 2022

Purpose of review

Cardiovascular disease remains one of the leading causes of morbidity and mortality today. The major risk factors for cardiovascular disease include type 2 diabetes mellitus, hypertension, tobacco smoking, elevated body mass index, and hyperlipidemia. The decision to use medication treatment for hyperlipidemia can be assisted using computerized decision tools.

Recent findings

The treatment of hyperlipidemia with 3-hydroxyl-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors has become widely recommended even though most people treated with them do not get clinical benefit, and the magnitude of their effect is dependent upon prior clinical risk. This article reviews recent research about the effectiveness of HMG-CoA reductase inhibitors, and the use of decision-making tools to assist the clinician in advising patients about the use of these medications.

On-line decision tools are available to estimate cardiovascular risk and to assist clinicians in helping their patients make their own decision about whether to take HMG-CoA reductase inhibitor medication to reduce cardiovascular risk.
Characteristics of plaque lipid-associated macrophages and their possible roles in the pathogenesis of atherosclerosis
Authors: Kim Kyeongdae , Park Sang-eun , Park Ji-su , Choi Jae-Hoon
Published: August 2022

Purpose of review

Recent findings from single-cell transcriptomic studies prompted us to revisit the role of plaque foamy macrophages in the pathogenesis of atherosclerosis. In this review, we compared the gene expression profile of plaque foamy macrophages with those of other disease-associated macrophages and discussed their functions in the pathogenesis of atherosclerosis.

Recent findings

To understand the phenotypes of macrophages in atherosclerotic aorta, many research groups performed single-cell RNA sequencing analysis and found that there are distinct phenotypic differences among intimal foamy, nonfoamy and adventitial macrophages. Especially, the plaque foamy macrophages express triggering receptor expressed on myeloid cells 2 (TREM2), a key common feature of disease-associated macrophages in Alzheimer's disease, obesity, cirrhosis and nonalcoholic steatohepatitis. These TREM2+ macrophages seem to be protective against chronic inflammation.

As the gene expression profile of plaque foamy macrophages is highly comparable to that of lipid-associated macrophages from obesity, we named the plaque foamy macrophages as plaque lipid-associated macrophages (PLAMs). PLAMs have a high level of gene expression related to phago/endocytosis, lysosome, lipid metabolism and oxidative phosphorylation. Considering the protective function of lipid-associated macrophages against adipose tissue inflammation, PLAMs may suppress atherosclerotic inflammation by removing modified lipids and cell debris in the plaque.
Mechanisms of nonalcoholic steatohepatitis-associated cardiomyopathy: key roles for liver–heart crosstalk
Authors: Njoku Dolores B. , Schilling Joel D. , Finck Brian N.
Published: August 2022

Purpose of review

Nonalcoholic steatohepatitis (NASH) is a multisystem disease that affects not only the liver but also heart, pancreas, and kidney. We currently lack a comprehensive understanding of mechanisms responsible for the development of NASH-associated cardiomyopathy or the influence of sex on pathophysiology. There is a critical need to address these gaps in knowledge in order to accelerate translation of knowledge into clinical practice.

Recent findings

NASH and cardiovascular disease share common risk factors such as chronic inflammation, hyperlipidemia, and insulin resistance. Early cardiac dysfunction in NASH that is independent of obesity or other cardiometabolic risk factors suggests roles for liver–heart crosstalk in disease pathogenesis. Inflammation is a driving force in the pathogenesis of NASH, and it is likely that ‘spill over’ of NASH inflammation contributes to the development of cardiomyopathy. However, molecular and cellular mechanisms that mediate NASH-associated cardiomyopathy remain unclear because of inherent limitations of experimental models. Even so, recent studies implicate inflammatory, metabolic, and physiologic mechanisms that enhance our understanding of NASH-associated cardiomyopathy and the role of liver–heart crosstalk.

An innovative, detailed, and mechanistic understanding of NASH-associated cardiomyopathy is relevant to public health and will be fundamental for the comprehensive care of these patients.
Proposal of index to evaluate caregivers’ fear of care recipient falls
Authors: Kakehi Tomohiro , Tamura Naoki , Zenta Masashi , Suzuki Yasunari , Nakajima Kyoko , Wada Hiromu , Ishimori Takuya , Bessho Masahiko , Kakuda Wataru
Published: August 2022

This study aimed to identify evaluation items that can be used to create an index to evaluate caregivers’ fear of care recipient falls. A three-round Delphi method was conducted with medical professionals engaged in discharge support for patients with fall-related fractures. In the first round, a working group brainstormed evaluation items. In the second and third rounds, opinions of medical professionals were quantified and evaluation items were refined. The Delphi method showed convergence of opinion with Kendall’s W of 0.561 in the third round. Of the 109 evaluation items pooled in the first round, the consensus was reached on the importance of 19 items and one more item was additionally included. The 20 items may be useful for creating an index that sensitively measures caregivers’ fear of care recipient falls.
Xanthomatous Giant Cell Renal Cell Carcinoma
Authors: Argani Pedram , Matoso Andres , Pallavajjalla Aparna , Haley Lisa , Tseh-Lin Ming , Ng Jessica , Chow C.W. , Lotan Tamara , Mehra Rohit
Published: August 2022

Over the past decade, several distinct novel renal epithelial neoplasms driven by underlying tuberous sclerosis comples (TSC)/mammalian target of rapamycin (MTOR) pathway mutations have been described. We report herein two distinctive TSC2-mutated renal cell carcinomas which do not fit any previously described entity. The two renal carcinomas occurred in young patients (ages 10 and 31 y), and were characterized by highly permeative growth within the kidney with metastases to perirenal lymph nodes. The neoplastic cells were predominantly large, multinucleated giant cells having variably eosinophilic to xanthomatous cytoplasm with basophilic stippling and frequent vacuolization. While the discohesive nature of the neoplastic cells, xanthomatous cytoplasm, immunoreactivity for histiocytic markers and minimal immunoreactivity for conventional epithelial markers raised the possibility of a histiocytic neoplasm, multifocal immunoreactivity for cytokeratin 20 helped establish their epithelial nature. Despite the aggressive growth pattern of these neoplasms and lymph node metastases, mitotic figures were rare and Ki-67 indices were low (<1%). One patient with follow-up shows no evidence of disease seven years after nephrectomy with no adjuvant therapy. Next-generation sequencing demonstrated TSC2 mutations in each case. By immunohistochemistry, downstream markers of mTOR pathway activation S6K1, 4EBP1, and glycoprotein nonmetastatic melanoma protein B were all highly expressed in these neoplasms, suggesting mTOR pathway activation as the neoplastic driver. While the cytokeratin 20 immunoreactivity and focal basophilic cytoplasmic stippling suggest a relationship to eosinophilic solid and cystic renal cell carcinoma, and cytoplasmic vacuolization suggests a relationship to eosinophilic vacuolated tumor, these neoplasms appear to be distinctive given their permeative growth patterns and predominant xanthomatous giant cell morphology. Addition of cytokeratin 20 to a panel of epithelial markers helps avoid misdiagnosis in such cases.