bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Community-acquired Raoultella Ornithinolytica Septicemia
Authors: Yaprak Deniz , Misirligil Mina , Bozat Ali Dinç , Karagol Belma Saygili
Published: July 2021

Raoultella ornithinolytica is an opportunistic, aquaphilic and Gram-negative bacterium. Immune deficiency states and indwelling catheters provide a basis for most of the infections arising. R. ornithinolytica septicemia (ROS) is extremely rare in neonates but can be life threatening. Community-acquired ROS has not been described in neonates before. The diagnosis of neonatal septicemia is occasionally complicated by unusual clinical presentations. Pyloric stenosis is manifested by projectile, nonbilious vomiting and late findings, including weight loss, dehydration and electrolyte abnormalities beyond 4–6 weeks old. Community-acquired neonatal septicemia symptoms can sometimes be confused with symptoms of gastrointestinal obstructions in patients without risk factors for sepsis. Early diagnosis and appropriate antibiotics are essentials for a good prognosis in neonatal septicemia. Herein, we present a novel case of community-acquired ROS with an unusual presentation in a term infant and a review of the literature about ROS in the neonatal period.
Rat Bite Fever: Variability in Clinical Presentation and Management in Children
Authors: Hadvani Teena , Vallejo Jesus G. , Dutta Ankhi
Published: July 2021

Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.
Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America
Authors: Yock-Corrales Adriana , Lenzi Jacopo , Ulloa-Gutiérrez Rolando , Gómez-Vargas Jessica , Antúnez-Montes Omar Yassef , Rios Aida Jorge Alberto , del Aguila Olguita , Arteaga-Menchaca Erick , Campos Francisco , Uribe Fadia , Hernández Díaz Roger , Buitrago Andrea Parra , Londoño Lina Maria Betancur , Kozicki Verónica , Brizuela Martin , Buonsenso Danilo
Published: July 2021

Background:

To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).

Methods:

Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes.

Findings:

One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant.

Conclusions:

Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
Response to Vaccination in Infants Exposed to Antitumor Necrosis Factor Alpha In Utero
Authors: Wieringa Jantien W. , van Beek Ron H. T. , Rövekamp Lyanne W. , Driessen Gertjan J. A. , van Wering Herbert M.
Published: July 2021

In this retrospective cohort study, the response to routinely administered Haemophilus influenzae type B vaccine, pneumococcal and pertussis vaccinations in 27 children exposed to antitumor necrosis factor alpha (anti-TNFα) during pregnancy was measured. The overall vaccination response seems comparable for children exposed to anti-TNFα and healthy infants. After primary vaccination series, inadequate response was present in some patients and might be related to exposure to anti-TNFα.
Development of a Teledermatology Service in Rural Washington State Using the Doctor of Nursing Practice Skill Set and Implementation Science
Authors: Norris Samantha Hastie , Matthews Sarah W. , Hogan Molly T.
Published: July 2021

Teledermatology increases access to dermatologic care in rural communities and is an effective strategy to decrease unnecessary dermatology referrals. At Confluence Health, the largest rural healthcare organization in Washington State, the average dermatology appointment wait time is approximately 7 months. This delay is more than 6 times the national average wait time of 33.9 days, making the need to increase access to care significant. To address this gap in care, a consultation service using store-and-forward teledermatology was designed, guided by the Knowledge-to-Action framework. This framework is an effective tool used in implementation science to guide the translation of evidence-based knowledge into practice. Store-and-forward telehealth allows for asynchronous electronic transmission of digital images to a specialist who later formulates a diagnostic impression and management plan. Since the outbreak of the COVID-19 pandemic, Confluence Health has swiftly adopted real-time video visits and plans to integrate this store-and-forward teledermatology consultation service by December 2020. This article examines a systems-level quality improvement initiative, facilitated by a Doctor of Nursing Practice-prepared nurse practitioner, with the aim of improving access to care and health outcomes.
Evaluation of association studies and a systematic review and meta-analysis of VDR polymorphisms in type 2 diabetes mellitus risk
Authors: Liu Yao , Guo Xin , Huang Shao-Yan , Gong Luan , Cui Jin-Hui , Shen Hu-Wei , Ye Xiang-Hua , He Xiao-Feng
Published: July 2021

Numerous original studies and 4 published meta-analyses have reported the association between the Vitamin D receptor (VDR) BsmI, FokI, ApaI, and TaqI polymorphisms and type 2 diabetes mellitus (T2DM) risk. However, the results were inconsistent. Therefore, an updated meta-analysis was performed to further explore these issues.

To further explore the association between the VDR BsmI, FokI, ApaI, and TaqI polymorphisms and T2DM risk.

PubMed, EMBASE, Scopus, and Wanfang databases were searched. The following search strategy were used: (VDR OR vitamin D receptor) AND (polymorphism OR variant OR mutation) AND (diabetes OR mellitus OR diabetes mellitus). Pooled crude odds ratios with 95% confidence intervals were applied to evaluate the strength of association in 5 genetic models. Statistical heterogeneity, the test of publication bias, and sensitivity analysis were carried out using the STATA software (Version 12.0). To evaluate the credibility of statistically significant associations, we applied the false-positive report probabilities (FPRP) and Bayesian false discovery probability (BFDP) test.

Overall, the VDR BsmI polymorphism was associated with a significantly decreased T2DM risk in Asians; the VDR FokI polymorphism was associated with a significantly decreased T2DM risk in Asians, African countries, and Asian countries; the VDR ApaI polymorphism was associated with a significantly decreased T2DM risk in Caucasians and North American countries.

On the VDR ApaI polymorphism, a significantly increased T2DM risk was found in a mixed population. However, when we further performed a sensitivity analysis, FPRP, and BFDP test, less-credible positive results were identified (all FPRP > 0.2 and BFDP > 0.8) in any significant association.

In summary, this study strongly indicates that all significant associations were less credible positive results, rather than from true associations.
Association between CASC16 rs4784227 polymorphism and breast cancer susceptibility
Authors: Liang Xiong-Shun , Mo Jun-Luan , Hu Li-Ming , Gong Chun-Mei , Liu Tao , Hong Wen-Xu , Yin Ji-Ye , Liu Zhao-Qian , Zhou Hong-Hao
Published: July 2021

Objective:

To explore whether rs4784227 polymorphism of CASC16 is correlated with risk of breast cancer.

Methods:

Relevant studies up to December 24, 2020 were searched in PubMed, Embase, Web of Science, CNKI, VIP, and WANFANG databases. Data were analyzed by using Stata 12.0. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and country-based subgroup analyses were conducted. Sensitivity analysis was conducted to assess the stability of the results. Publication bias was assessed by using the Egger regression asymmetry test and visualization of funnel plots.

Results:

Seven case-control studies enrolling 4055 breast cancer cases and 4229 controls were included. rs4784227 was found significantly associated with increased risk of breast cancer in a dominant (OR = 1.301, 95% CI = 1.190–1.423, P < .001), a recessive (OR = 1.431, 95% CI = 1.216–1.685, P < .001), and an allele model (OR = 1.257, 95% CI = 1.172–1.348, P < .001), while an over-dominant model showed that rs4784227 was correlated with decreased breast cancer risk (OR = 0.852, 95% CI = 0.778–0.933, P = .001).

Conclusion:

The rs4784227 polymorphism of CASC16 gene is correlated with breast cancer susceptibility.
Elevated neutrophil–lymphocyte ratio can be a biomarker for predicting the development of cervical intraepithelial neoplasia
Authors: Xu Lina , Song Jiandong
Published: July 2021

Cervical intraepithelial neoplasia (CIN) is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. In the present study, we investigated whether measuring the neutrophil-lymphocyte ratio (NLR) can be useful for predicting the risks of developing cervical lesions.

This is a retrospective analysis of 212 women who were enrolled in this study. Among them, 106 patients with histologically confirmed CIN1-3 who were treated with loop electrosurgical excision procedure or cold knife cone in the Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University between July 30th 2016 and January 30th 2019.

Among the 106 patients in the CIN group, cytology showed minor abnormality which included atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in 42, high-grade squamous intraepithelial lesion in 62, and squamous cell carcinoma in 2 patients. We found that the NLR has no significant difference between the control group and the CIN1 group, while there were significant differences between CIN1 and CIN2, and CIN2 and CIN3 group. The median of the NLR was higher in the HPV16-persistent groups than in the HPV-negative group.

In conclusion, a high NLR value independently predicts CIN and the stage of CIN. The NLR may help doctors evaluate outcomes of patients received conization and choose alternative therapies for patients with high NLR value.
Effects of ABCB1 gene polymorphism on the efficacy of antidepressant drugs
Authors: Zheng Xiaoying , Fu Zejuan , Chen Xiaomei , Wang Mingxia , Zhu Rixia
Published: July 2021

Background:

Antidepressant drugs are mainly used to treat depression clinically. ABCB1 affects the P-glycoprotein activity and changes the amount of drugs in the blood tissue barrier that can be squeezed back into the blood, thus affecting the efficacy of antidepressants. In this present study, Meta-analysis was performed to further investigate the influences of ABCB1 gene polymorphism on antidepressant response.

Methods:

Relevant literatures were searched from the PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, China Biology Medicine disc, and Wan Fang databases up to May 2021 without any language restrictions. STATA 16.0 software was applied for this meta-analysis. Odds ratio (OR) and its corresponding 95% confidence interval (CI) were calculated.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This meta-analysis will summarize the effects of ABCB1 gene polymorphism on antidepressant response.
An artificial neural network model to predict the mortality of COVID-19 patients using routine blood samples at the time of hospital admission
Authors: Lin Ju-Kuo , Chien Tsair-Wei , Wang Lin-Yen , Chou Willy
Published: July 2021

Background:

In a pandemic situation (e.g., COVID-19), the most important issue is to select patients at risk of high mortality at an early stage and to provide appropriate treatments. However, a few studies applied the model to predict in-hospital mortality using routine blood samples at the time of hospital admission. This study aimed to develop an app, name predict the mortality of COVID-19 patients (PMCP) app, to predict the mortality of COVID-19 patients at hospital-admission time.

Methods:

We downloaded patient records from 2 studies, including 361 COVID-19 patients in Wuhan, China, and 106 COVID-19 patients in 3 Korean medical institutions. A total of 30 feature variables were retrieved, consisting of 28 blood biomarkers and 2 demographic variables (i.e., age and gender) of patients. Two models, namely, artificial neural network (ANN) and convolutional neural network (CNN), were compared with each other across 2 scenarios using

An app for predicting the mortality of COVID-19 patients was developed using the model's estimated parameters for the prediction and classification of PMCP at an earlier stage. Feature variables and prediction results were visualized using the forest plot and category probability curves shown on Google Maps.

Results:

We observed that

Conclusions:

Our new PMCP app with ANN model accurately predicts the mortality probability for COVID-19 patients. It is publicly available and aims to help health care providers fight COVID-19 and improve patients’ classifications against treatment risk.
Poor clinical and virological outcome of nucleos(t)ide analogue monotherapy in HBV/HDV co-infected patients
Authors: Scheller Laura , Hilgard Gudrun , Anastasiou Olympia , Dittmer Ulf , Kahraman Alisan , Wedemeyer Heiner , Deterding Katja
Published: July 2021

Co-infection of Hepatitis B (HBV) and Delta viruses (HDV) represent the most severe form of viral hepatitis. While treatment with pegylated Interferon alpha (PEG-IFNα) is well established, therapy with nucleoside or nucleotide analogues (NA) has been a matter of debate. We aimed to investigate the role of NA treatment in a well-defined single centre cohort.

In a retrospective approach, we observed 53 HDV RNA positive and/or anti-HDV-positive patients recruited at a German referral centre between 2000 and 2019. Patients were followed for at least 3 months (mean time of follow up: 4.6 years; range: 0.2–14.1 years). Patients who had liver transplantation or hepatocellular carcinoma at the time of presentation were excluded. 43% (n = 23) were treated with NA, 43% (n = 23) received IFNα-based therapies and 13% (n = 7) were untreated.

Liver cirrhosis was already present in 53% (28/53) of patients at first presentation. During follow-up, liver-related endpoints developed in 44% of all patients (n = 23). NA-treatment was associated with a significantly worse clinical outcome (P = .01; odds ratio [OR] = 4.92; CI = 1.51–16.01) compared to both, untreated (P = .38; OR = 0.46; CI = 0.80–2.61) and IFNα-based-treated patients (P = .04; OR = 0.29; CI = 0.89–0.94) in univariate logistic regression analysis. HBsAg levels declined by more than 50% during NA-based therapy in only 7 cases (7/23; mean time: 3.6 years; range: 0.8–8.5 years) and during IFNα-based therapy in 14 cases (14/23; mean time: 2.8 years, range 0.7–8.5 years). HDV RNA became undetectable during follow up in 30% of patients receiving NA alone (7/23; mean time: 5.0 years; range: 0.6–13.5 years), in 35% of patients receiving IFNα-based therapy (8/23; mean time: 2.9 years, range: 0.3–7.6 years).

The effect of NA in patients with HBV/HDV co-infection is limited. Treatment with NA was associated with a higher likelihood of clinical disease progression. Interferon alpha therapy was beneficial in reducing liver complications and improves long-term outcome.
Influential factors and prediction model of mammographic density among Chinese women
Authors: Shang Mu Yan , Guo Shuai , Cui Ming Ke , Zheng Yan Fu , Liao Zhi Xuan , Zhang Qiang , Piao Hao Zhe
Published: July 2021

To evaluate the characteristics and influential factors of breast density and establish a new model for predicting breast density in Chinese women, so as to provide a basis for breast cancer screening techniques and duration.

A total of 9412 women who were selected from screening and intervention techniques for Breast and Cervical Cancer Project between April 2018 and June 2019 were enrolled in this study. Selected women were randomly assigned to training and validation sets in a ratio of 1:1. Univariable and multivariable analyzes were performed by Logistic regression model. Nomogram was generated according to the results of multivariate analysis. Calibration, area under curve (AUC) and akaike information criterion (AIC) were used for measuring accuracy of prediction model.

There were 377 (4.0%) women in breast imaging reporting and data system (BI-RADS) A category, 2164 (23.0%) in B category, 5749 (61.1%) in C category and 1122 (11.9%) in D category. Age duration, educational attainment, history of benign diseases, breastfeeding history, menopausal status, and body mass index (BMI) were imputed as independent influential factors for breast density in multivariable analysis. The AUC and AIC of training and validation set were 0.7158, 0.7139, and 4915.378, 4998.665, respectively.

This study indicated that age, educational attainment, history of benign breast disease, breastfeeding history, menopausal status and BMI were independent influential factors of breast density. Nomogram generated on the basis of these factors could relatively predict breast density, which in turn could be used for recommendations of breast cancer screening techniques.
Effects of deferred versus immediate stenting on left ventricular function in patients with ST elevation myocardial infarction
Authors: Kook Hyungdon , Lee Hyun-Jong , Kim Mi-Na , Yu Cheol Woong , Kim Je Sang , Joo Hyung Joon , Park Jae Hyoung , Hong Soon Jun , Kim Tae Hoon , Jang Ho-Jun , Park Jin-Shik , Choi Rak Kyeong , Choi Young Jin , Kim Yang Min , Lim Do-Sun , Ro Young Moo
Published: July 2021

Background:

Previous studies have shown conflicting results on the benefits of deferred stenting (DS) in infarct size and the incidence of microvascular obstruction in patients with ST elevation myocardial infarction (STEMI). However, effect of DS on left ventricular (LV) function was not known. We aimed to evaluate whether DS improve LV function and relevant clinical outcomes after STEMI, using follow-up data from the INNOVATION study (NCT02324348).

Methods:

In total, 114 patients were randomly assigned to DS group or immediate stenting (IS) group at a 1:1 ratio. LV functional remodeling indices and MACE (major adverse cardiac events: a composite of death, non-fatal MI, unplanned target vessel revascularization, or hospitalization due to heart failure) were compared between DS and IS groups.

Results:

Serial echocardiographic analyses were completed in 89 subjects (78%). There were no significant changes in LV volume in either group. While LV ejection fraction and wall motion score index (WMSI) improved in both groups during follow-up, the increments were not statistically different between the 2 groups (4.3 ± 8.2 vs 3.2 ± 7.1, P = .504 for ΔLV ejection fraction; –0.16 ± 0.25 vs –0.16 ± 0.25, P = .99 for ΔWMSI). However, E/e′’ was decreased and e′ was increased only in the DS group (–3.31 ± 5.60 vs –0.46 ± 3.10, P = .005 for ΔE/e′; 0.77 ± 1.71 vs –0.22 ± 1.64, P = .009 for Δe′). The incidence of major adverse cardiac events was numerically lower in the DS group than in the IS group without a statistical significance at 1-year follow-up.

Conclusions:

Routine DS improved LV diastolic function but not systolic function compared with IS in patients with STEMI.
Cystatin C predicts the risk of incident cerebrovascular disease in the elderly
Authors: Zheng Xin , She Hong-da , Zhang Qiao-xin , Si Tong , Wu Ku-sheng , Xiao Ying-xiu
Published: July 2021

Background:

Stroke is the third leading cause of global year of life lost in all-age and second-ranked cause of disability adjusted life years in middle-aged and elder population. Therefore, it is critical to study the relationship between vascular-related risk factors and cerebrovascular diseases. Several cross-sectional studies have shown that Cystatin C (Cys C) is an independent risk factor for cerebrovascular diseases and levels of Cys C are significantly higher in stroke patients than in healthy individuals. In this meta-analysis, we introduce a Cox proportional hazards model to evaluate the causality between Cys C and the risk of cerebrovascular accident in the elderly.

Methods:

We searched PubMed, EMBASE, the Web of Science, and the Cochrane Library from 1985 to 2019 for studies on the relationship between serum Cys C and incidence stroke with Cox proportional hazards models. We conducted a subgroup analysis of the selected studies to determine a connection between atherosclerosis and stroke. Finally, 7 research studies, including 26,768 patients without a history of cerebrovascular, were studied.

Results:

After comparing the maximum and minimum Cys C levels, the hazard ratio for all types of stroke, including ischemic and hemorrhagic stroke, was 1.18 (95% confidence interval 1.04–1.31) with moderate heterogeneity (I
2 = 43.0%; P = .119) in a fixed-effect model after pooled adjustment for other potential risk factors. In the subgroup analysis, the hazard ratio and 95% confidence interval for Cys C stratified by atherosclerosis was 1.85 (0.97–2.72). As shown in Egger linear regression test, there was no distinct publication bias (P = .153).

Conclusion:

Increased serum Cys C is significantly associated with future stroke events in the elderly, especially in patients with carotid atherosclerosis. Thus, serum levels of Cys C could serve as a predicted biomarker for stroke attack.
Intervention for stress management among skilled construction workers
Authors: Iremeka Felicia Ukamaka , Okeke Somtochukwu A.C. , Agu Patricia Uzoamaka , Isilebo Nwamara Chidebere , Aneke Mary , Ezepue Evelyn Ijeoma , Ezenwaji Ifeyinwa O. , Ezenwaji Chisom Ogochukwu , Edikpa Edith , Chukwu Chukwuemeka Joseph , Eze Amaeze Fidelis , Omeje Hyginus Osita , Okereke Godwin Keres Okoro , Ogidi Chinenye Ifeoma , Chukwuji Chioma
Published: July 2021

Objective:

Previous studies have demonstrated the need for a stress management intervention among construction workers. Construction workers, despite their degree of stress, are expected to contribute to the accomplishment of projects on construction sites. This study aimed to ascertain the effect of a group rational emotive behavior therapy (group REBT) on stress management among a select sample of skilled construction workers in construction industry in Nigeria.

Methods:

With a randomized controlled trial design, 160 skilled construction workers completed the study and responded to the perceived stress scale-14 and work-related irrational beliefs questionnaire. Participants were randomly allocated to either the intervention group (n = 80) or the control group (n = 80). The main method of data analysis used in the study was repeated measures within-between subjects analysis of variance statistic.

Results:

Results show that group REBT significantly improved stress and work-related irrational beliefs scores of the skilled construction workers after they were exposed to the intervention and compared with their colleagues in the control group. The significant reduction in stress and work-related irrational beliefs scores of the treatment group were also sustained at follow-up.

Conclusion:

Group REBT was significant in reducing stress and work-related irrational beliefs among the skilled construction workers.
Predictors for intraoperative heart failure in children undergoing foreign-body removal
Authors: Yao Xianyi , Zhang Lei , Zhao Guangyu , Pang Haifeng , Li Tingting , Han Xiao , Liu Ming
Published: July 2021

This study aimed to determine the predictors for intraoperative heart failure (HF) in children undergoing foreign-body removal. The clinical data of all children with tracheobronchial foreign-body aspiration admitted to the First, Second, and Fourth Affiliated Hospitals of Harbin Medical University between January 1996 and September 2018 were analyzed. The variables with significant difference in univariate analysis were involved into the multivariate Logistic model to determine the predictors for intraoperative tachycardia. In total, 300 tracheobronchial foreign-body aspiration children were eligible for the study, among whom 60 cases (20%) suffered from HF during the operation. Between the children HF and those without HF, the differences were pronounced in history of allergy, history of asthma, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect (P < .05). Multivariate analysis results showed that history of allergy (odds ratio [OR]: 1.395, 95% confidence interval [95% CI]: 1.202–1.620, P < .001), congenital heart disease [OR: 3.071, 95% CI: 1.141–8.264, P < .001], preoperative respiratory infection [OR: 2.345, 95% CI: 1.027–5.355, P = .043], retention time of foreign bodies [OR: 1.013, 95% CI: 1.010–1.016, P < .001], duration of operation [OR: 1.030, 95% CI: 1.027–1.033, P < .001], and poor anesthesia effect [OR: 1.125, 95% CI: 1.117–1.134, P < .001] were identified as the influencing factors for intraoperative HF. In conclusions, for children undergoing foreign-body removal, history of allergy, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect are associated with an increased risk of intraoperative HF.
Beclin1 circulating level as predictor of carotid intima-media thickness in patients with type 2 diabetes mellitus
Authors: Naguib Mervat , Tarabay Aya , ElSaraf Nashwa , Rashed Lila , ElMeligy Amr
Published: July 2021

Type 2 diabetes (T2DM) represents a major risk factor for atherosclerosis that is the underlying cause of most cardiovascular diseases. Identifying reliable predictive biomarkers are needed to improve the long-term outcome in diabetic patients. Autophagy plays a pivotal role in the pathogenesis of atherosclerosis. Beclin1 is a key regulatory protein of autophagy and has been localized in human atherosclerotic lesions. However, the relation of serum level of Beclin1 and atherosclerosis in patients with diabetes has not been clarified yet.

To assess the relationship between serum level of Beclin1 and carotid intima-media thickness (CIMT) in patients with T2DM.

In this case-control study participants were recruited from tertiary care hospitals in Egypt. The study enrolled 50 patients with T2DM and 25 healthy subjects between January, 2019 and January, 2020. Age, gender, and body mass index were recorded for all subjects. Laboratory works up including glycated hemoglobin, lipid panel, and serum Beclin1 (by enzyme-linked immunosorbent assay) were measured. CIMT was assessed by color Doppler. Comparisons between patients and the control group were done using analysis of variance and Chi-square test. Correlations between CIMT and Beclin1 level and different variables were done using the Pearson correlation coefficient. Receiver operator characteristic curve was constructed with the area under curve analysis performed to detect the best cutoff value of Beclin1 for detection of CIMT > 0.05 cm.

The level of Beclin1 in the patient group was significantly lower compared with that in the control group (1.28 ± 0.51 vs 5.24 ± 1.22 ng/dL, P < .001). The level of Beclin1 apparently decreased in the higher CIMT group in T2DM patients. Serum Beclin1 levels were negatively correlated with CIMT (r = –0.762; P < .001), low-density lipoprotein-cholesterol (r = −0.283; P = .04), and triglycerides (r = −0.350; P = .01) but positively correlated with high-density lipoprotein-cholesterol (r = 0.491; P < .001) in patients with T2DM. Beclin1 level >2.2 ng/dL was an accurate predictor of CIMT >0.05 cm with an area under the curve value of 0.997, 93.9% sensitivity, and 100% specificity.

Beclin1 levels were negatively correlated with atherosclerotic load in patients with T2DM and it may be considered as a promising diagnostic and therapeutic target.
Effect and safety of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction
Authors: Wang Yuliang , Xing Jijie , Li Ying , Zhang Rui
Published: July 2021

Background:

As far as we know, no evidence has been established to assess the effects of acupuncture for acute cerebral infarction patients. Therefore, this systematic review and meta-analysis will be conducted to assess the efficacy and safety of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction.

Methods:

On June 20, 2021, the authors will perform a preliminary search in the PubMed, Embase, and Scopus databases using the following keywords: “acupuncture,” “acute cerebral infarction.” We will also examine the Clinical Trials Registry for other ongoing and unpublished studies. The inclusion criteria included (1) patients with acute cerebral infarction, (2) patients who received acupuncture, and (3) studies assessed cerebrovascular reserve, breath-holding index, Barthel index, and adverse events. All English language randomized controlled trials published within the last 20 years were eligible for inclusion. Primary outcome measures in our study are cerebrovascular reserve, and secondary outcome measures include the breath-holding index, Barthel index, and adverse events. All outcomes are pooled on a random-effect model.

Results:

The results of this research will be delivered in a peer-reviewed journal.

OSF registration number:

10.17605/OSF.IO/7M4BK.
HIV-1 molecular transmission network among sexually transmitted populations in Liaoning Province, China
Authors: Ma Ning , Chen Xing-hua , Zhao Yan , Kang Xu , Pan Shan , Yao Wen-qing
Published: July 2021

Introduction:

In recent years, with the development of molecular epidemiology, molecular transmission networks based on evolutionary theory and sequence analysis have been widely used in research on human immunodeficiency virus (HIV)-1 transmission dynamics and precise intervention for high-risk populations. The HIV-1 molecular transmission network is a new method to study the population's access to the network, the characteristics of clustering, and the characteristics of interconnection in the network. Here, we analyzed the characteristics of the HIV-1 molecular transmission network of sexually transmitted people in Liaoning Province.

Methods:

A study of HIV-infected persons who were sexually transmitted in Liaoning Province from 2003 to 2019. HIV-1 RNA was extracted, amplified and sequenced, and a phylogenetic tree was constructed to determine the subtype using the well matched pol gene region sequence. The gene distance between sequences was calculated, the threshold was determined, and the molecular transmission network was constructed.

Results:

109 samples of pol gene region were obtained. The main subtype of HIV-1 was CRF01_AE, followed by B, CRF07_BC, etc. 12.8% of them were resistant to HIV. At the threshold of 0.55 gene distance, 60.6% of them entered the HIV-1 molecular transmission network. Workers, sample source voluntary counseling and testing, other testing, subtype B and drug resistance are the factors influencing the access to HIV-1 molecular transmission network. The subtype of CRF01_AE formed 6 clusters in the molecular transmission network. In the network, the difference of connection degree between different subtypes was statistically significant.

Discussion:

The three subtypes CRF01_AE, CRF07_BC and B that enter the molecular transmission network do not have interconnections, and they form clusters with each other. It shows that the risk of transmission among the three subtypes is less than the risk of transmission within each subtype. The factors affecting HIV-1 entry into the molecular transmission network were occupation, sample source, genotype and drug resistance. The L33F mutation at the HIV-1 resistance mutation site constitutes the interconnection in the largest transmission cluster in the network. The epidemiological characteristics of HIV-infected persons in each molecular transmission cluster show that 97% of the study subjects come from the same area and have a certain spatial aggregation.

Conclusion:

Constructing a molecular transmission network and conducting long-term monitoring, while taking targeted measures to block the spread of HIV can achieve precise prevention and control.
Assessment of fetal cardiac diastolic function of gestational diabetes mellitus using dual-gate Doppler
Authors: Hou Qingsha , Yan Fang , Dong Xudong , Liu Huanling , Wu Jie , Li Jiao , Ding Yunchuan
Published: July 2021

Gestational Diabetes Mellitus (GDM), as a common complication of pregnancy, has an increasing trend globally. GDM leads to maternal complications and fetal complications. Fetal cardiac diastolic dysfunction is strongly associated with GDM. This study aims to assess the ventricular diastolic function of fetuses exposed to GDM by looking into the diagnostic parameters using both conventional method and Dual-gate Doppler method (DD). And to investigate the potential of DD method in early detection of fetal cardiac diastolic dysfunction.

56 women diagnosed with GDM and 55 non-GDM pregnant women were enrolled in their 24 to 30 weeks of gestation. Conventional method and DD method were applied to measure mitral and tricuspid inflow velocities E-waves, A-waves on pulsed-wave Doppler, and mitral and tricuspid annular velocities e′-waves, a’-waves on Tissue Doppler imaging. E/A, e’/a’ and E/e′ ratio was calculated. The difference between GDM and control groups was statistically tested and analysed using one-sample Kolmogorov-Smirnov test, Student t test, Mann-Whitney U test and Kruskal-Wallis test and Bland–Altman plot analysis.

Intraobserver intraclass correlation coefficients of E/A, e’/a’, and E/e’ value of both mitral and tricuspid valve are all greater than 0.80, while interobserver intraclass correlation coefficients are between 0.71 and 0.88. Right (6.35 vs 6.79; P = .001) ventricular function showed significantly lower E/e’ ratios in the GDM group compared with control fetuses by conventional method. Both left (6.16 vs 6.59; P = .036) and right (6.28 vs 6.75; P = .01) ventricular function showed significantly lower E/e’ ratios in the GDM group compared with control fetuses by DD method.

Exposure to high level of maternal blood glucose leads to impaired diastolic function in the fetuses. Fetal right ventricular function is a potential key point to study to enable an early detection for fetal diastolic dysfunction since the alteration and damage are more likely to happen in right ventricular. Measurement of E/e’ ratio using DD method is considered as a promising method in fetal cardiac diastolic function assessment. Well or poorly control of the GDM does not have significant influence on the fetal diastolic function thus an early detection of GDM and GDM induced fetal cardiac dysfunction is necessary.
Cryptococcal infection presenting as soft tissue abscess and arthritis
Authors: Cho Yong Jin , Han Song Iy , Lim Sung-Chul
Published: July 2021

Rationale:

Cryptococcal infection has been documented in immunocompromised patients. AIDS and renal transplant recipients account for majority of the cases. Most cases present with central nervous system or disseminated disease, with only few presenting soft tissue, bone, and joint manifestations.

Patient concerns:

We present a case of soft tissue mass in a 66-year-old female renal transplant recipient and that of arthritis in a 64-year-old immunocompetent man who presented pseudogout arthropathy. Chest radiographies of both cases were negative. Biopsy revealed cryptococcal organisms. Blood culture or cerebrospinal fluid sampling indicated positive results for cryptococcal antigen.

Diagnosis:

Cryptococcus neoformans was recovered in the wound culture.

Interventions:

The patients received intravenous fluconazole and flucytosine, followed by oral fluconazole administration.

Outcomes:

Symptomatic improvements were achieved and no subsequent relapses were observed.

Lessons:

The authors experienced 2 cases of cryptococcosis with very unusual clinical presentation. Early clinical suspicion and serum cryptococcal antigen testing can help in rapid appropriate diagnosis in immunocompetent as well as immunocompromised patients even in the absence of pulmonary involvement.
Interaction between ALDH2 rs671 and life habits affects the risk of hypertension in Koreans
Authors: Kim Sung-Soo , Park Sangjung , Jin Hyun-Seok
Published: July 2021

Aldehyde dehydrogenase-2 (ALDH2) is associated with the risk of hypertension, and the effects of lifestyle factors on blood pressure vary according to genotype. Among the Han Chinese, the risk of hypertension is lower in the group with the rs671 A allele than in the group with the G allele, and there is a significant association between the frequency of fried food consumption and hypertension. However, the A allele significantly increases the risk of hypertension with increased fried food intake. This study aimed to investigate the effect of the relationship between ALDH2 polymorphism and complex lifestyle habits (fried food consumption and exercise) on hypertension.

rs671 polymorphisms of ALDH2 were examined using Korean genome and epidemiology data from 8157 hypertensive cases and 9550 controls. Further, we investigated whether the A allele is protective against hypertension in Koreans and explored the effect of the combination of fried food intake and exercise habits on hypertension by genotype.

The genotype frequencies of rs671, which is specific to East Asia, were 2.51% AA, 26.66% GA, and 70.83% GG in the Korean population. The group with inactive aldehyde dehydrogenase-2 had a low odds ratio [OR = 0.75 (95% CI:0.69–0.80), P = 4.35 × 10−14] of hypertension, and low metabolism of acetaldehyde. Subjects carrying the A allele exhibited an increased risk of hypertension with increased fried food intake without exercise [OR = 2.256 (95% CI:1.094–4.654), P = .028].

ALDH2 polymorphism and complex lifestyle habits (fried food consumption and exercise) are associated with the risk of hypertension. Further, the A allele is associated with a low risk of hypertension, but it increases the risk of hypertension as fried food intake without exercise increases.
Feasibility of cortical bone trajectory screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration
Authors: Wang Long , Zhao Yong-Hui , Cai Xing-Bo , Liang Jin-Long , Luo Hao-Tian , Ma Yu-Long , Xu Yong-Qing , Lu Sheng
Published: July 2021

Background:

To investigate the feasibility of using cortical bone trajectory (CBT) screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration and to provide a reference for clinical practice.

Methods:

Computed tomography scans of the lumbar spines of 36 patients in our hospital were used. Sixteen males and 20 females with an average age of 65.5 ± 10.5 years (range: 46 to 83 years) were included. Three-dimensional reconstruction was performed using computer software. Screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and traditional pedicle screws were placed using the standard method. After completing screw placement, simulated placement of CBT screws was performed separately. No overlap occurred between the two screws in the process of CBT screw placement, and the placement point and direction were adjusted until screw placement completion. After all screw placement simulations were complete, according to the contact area of the cortical bone of the screw trajectory and the screw puncture position and distance through the trajectory, the screw placement results were categorized as excellent, good, general, and failure. Excellent and good ratings were considered successful, while a general rating was regarded as acceptable. Then, the success rate and acceptable rate of each segment of the lumbar spine were calculated.

Results:

Three hundred and sixty screw placement simulations were performed in lumbar pedicles, and 72 CBT screws were implanted in each vertebral body of the lumbar spine. The success rates in the L1 to L5 segments were 73.6%, 80.6%, 83.3%, 88.9%, and 77.8%, respectively, and the acceptable rates were 91.7%, 97.2%, 97.2%, 100%, and 91.7%, respectively. The overall success rate and acceptable rate of CBT screw placement in the lumbar spine were 80.8% and 95.6%, respectively.

Conclusion:

CBT screws are feasible for bridging fixation in lumbar adjacent segment degeneration revision surgery, and the accuracy of screw placement in different lumbar vertebrae varies.
Concomitant Pediatric Burns and Craniomaxillofacial Trauma
Authors: Xun Helen , Lopez Christopher D. , Lee Erica , Dorafshar Amir H. , Manson Paul N. , Caffrey Julie , Hultman Scott , Lopez Joseph , Redett Richard J.
Published: July 2021

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.
Single-Sided Segmental Maxillary Osteotomies for Alveolar Cleft Deformities
Authors: Reategui Alvaro , Khetpal Sumun , Peck Connor , Lopez Joseph , Steinbacher Derek
Published: July 2021

Although the use of a one-sided segmental maxillary osteotomy has been described for repairing alveolar clefts, there remains little consensus regarding the indications and outcomes of such approaches. This brief clinical note aims to summarize previous studies of one-sided segmental maxillary osteotomies for alveolar cleft (AC) repair. A literature search yielded only 2 articles that described the use of a single-sided segmental maxillary osteotomies (SMO) for AC repair. The overall outcomes for the implementation of SMO in correcting AC were positive without major or minor complications. Although the available studies show promising results for the single-sided SMO technique, further validation is warranted to assess the indications and outcomes for this technique.
Chondrogenic Characteristics of Auricular Chondrocytes Cocultured With Adipose-Derived Stem Cells are Superior to Stromal Vascular Fraction of Adipose Tissue
Authors: Jia Lingling , Yang Mingyong , Jiang Haiyue , Liu Xia
Published: July 2021

Reconstruction of craniofacial cartilage defects is among the most challenging operations in facial plastic surgery. The co-culture system of partial replacement of chondrocytes by stem cells has been confirmed effective in the repair of cartilaginous defects. The aim of this study is to compare chondrogenic properties of expanded adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF), including ADSCs/SVF monoculture and coculture with rabbit auricular chondrocytes (ACs). Analysis of morphology, histology, real-time polymerase chain reaction and glycosaminoglycans (GAG) quantification were performed to characterize the chondrogenesis of pellets. The triple differentiation potential of ADSCs had been confirmed. Further, using flow cytometry, the authors demonstrated that ADSCs and SVF have different characteristics in cell surface markers, and ADSCs are more enriched in cells from the mesenchymal lineage than SVF. GAG production of ADSCs is significantly higher than that of SVF in pellet monoculture, and pellet coculture of ADSCs and ACs are better in depositing cartilage matrix than the mixture of SVF and ACs. Our study suggests that ADSCs may be more suitable seed cells for craniofacial cartilage defect or deformity repair.
Focal Idiopathic Calvarial Thinning: A Condition of Uncertain Prevalence and Significance
Authors: Watson Luke , Hovav Oliver , Phua Yun
Published: July 2021

Focal thinning of the calvarial bones unrelated to an underlying systemic disease is uncommon. Of such cases documented in the medical literature, most are bilateral parietal bone thinning, which tends to affect elderly females and results in bilateral symmetric, regularly shaped depressions of the skull. The authors describe 2 cases of unilateral, focal, irregularly shaped calvarial thinning in adolescent males that occurred without an obvious precipitating incident and were unrelated to systemic disease, a known syndrome or previous trauma. The nature and physical parameters of the deformities are demonstrated here and specific historic features such as age of onset and mode of obstetric delivery are explored. The clinical significance and potential pathogenesis of this finding is unclear, though these cases are relevant in highlighting a novel presentation that we henceforth term focal idiopathic calvarial thinning.