bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children
Authors: Abramavicius Silvijus , Stundziene Alina , Jankauskaite Lina , Vitkauskiene Astra , Kowalski Ireneusz M. , Wojtkiewicz Joanna , Stankevicius Edgaras
Published: October 2021

The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections.

We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects.

A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby–Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile.

Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects.

The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events.
Abdominal changes in patients with degenerative spinal deformity
Authors: Guo Chen , Xu Shuai , Liang Yan , Meng Fanqi , Zhu Zhenqi , Liu Haiying
Published: October 2021

The incidence of degenerative spinal deformity (DSD) is increasing with the age while the effect of DSD on the abdominal cavity parameters is unclear.

To identify the characteristics of abdominal change in DSD and to explore the correlation between the abdominal cavity volume (ACV) and various types of DSD.

The retrospective study included 95 patients with DSD and 100 subjects without deformity as control group. The Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis (TLK) angle, and lumbar kyphosis angle were obtained through full-length X-ray. The ACV was calculated by measuring the longitudinal, transversal, and coronal diameters of the abdominal cavity on magnetic resonance imaging (MRI). The rotation of the diaphragm (DR) were measured in the sagittal plane. DSD ones were divided into degenerative lumbar scoliosis (DLS group), degenerative kyphosis (DK group), and degenerative lumbar scoliokyphosis (DKS group).

Compared to control group, ACV of the DLS and DKS group was smaller. The distance between the xiphoid process and spine in DLS group was shorter and DR in DK group and DKS group was smaller. The inter-group analysis showed ACV and the shortest distance between xiphoid process and spine in DLS and DKS group were significantly lower than those in DK group. The degree of DR in DK group and DKS group was higher than that in the DLS group. Multiple linear regression analysis showed Cobb angle and weight were influencing factors of ACV with ACV = 0.67 × weight – 0.19 × Cobb angle + 2231.8. The DR was affected by TLK with DR = 25.82 – 0.42 × TLK.

DLS can cause the decrease of ACV. DK will not cause changes of ACV but is related to the degree of kyphosis. DKS will impact both ACV and DR.
Intensive competency-based training strategy in a National Hospital in times of Pandemic
Authors: Camputaro Luis A. , Bello Quezada Manuel E. , Hoyos Arango William A. , Bortoli Romina G. , Ruiz Zelaya Francisco A. , Diaz Moreno Mario M. , Delgado Delgado Josue M. , Márquez Magaña Mauricio S. , Vigne Cuellar Paolo A. , Sanchez Maximiliano I.
Published: October 2021

COVID-19 has revealed the lack of capacity to respond to a pandemic. This article aims to

Given the large group of professionals to train (Physicians and Paramedics), a compact course based on competencies was designed and executed. In order to optimize instruction times and the need for assistance care, the course was scheduled for a total duration of 4 hours and was imparted by selected instructors from August 17 to 21, August 24 to 28, and September 7 to 11, 2020 (15 working days in total). The Research Ethics Committee of Hospital Nacional El Salvador approved the study. The effectiveness of the educational intervention was evaluated by a pre–post-survey of knowledge perception on 4 domains with 10 areas of skills in intensive care.

100% (n: 981) of the participants were trained in hands-on care of COVID-19 patients; 66.3% female–33.7% male, with an average age of 29.92 ± 5.82 years. The course achieved an increased perception of knowledge in the 10 areas evaluated with a mean of 5.72 ± 0.59 to 8.60 ± 0.19 (P < .0001).

The short intensive training in competencies carried out at Hospital Nacional El Salvador proved to be effective in improving the knowledge of healthcare workers engaged in patient care.
Evaluation of dopamine transporter density in healthy Brazilians using Tc-99m TRODAT-1 SPECT
Authors: Reis Marilia Alves dos , Gadelha Ary , Felício André C. , Hoexter Marcelo Queiroz , Batista Ilza Rosa , Braga-Neto Pedro , Calzavara Mariana , Cavagnolli Daniel Alves , Higuchi Cinthia , Leite Melissa Furlaneto Lellis , Nogueira Solange Amorim , Wagner Jairo , Castiglioni Mario Luiz Vieira , Shih Ming Chi , Bressan Rodrigo Affonseca
Published: October 2021

The presynaptic dopamine transporter (DAT) modulates the uptake of dopamine by regulating its concentration in the central nervous system. We aimed to evaluate the DAT binding potential (DAT-BP) in a sample of healthy Brazilians through technetium-99 metastable TRODAT-1 single-photon emission computed tomography imaging.

We selected 126 healthy individuals comprising 72 men and 54 women, aged 18 to 80 years. We conducted semi-quantitative evaluation in transaxial slices, following which we identified the regions of interest in the striatal region using the occipital lobe as a region of non-specific DAT-BP.

We found a decrease in DAT-BP in healthy individuals aged over 30 years, culminating in a 42% mean reduction after 80 years. There was no difference in the decrease by age group between the right (linear regression test [R
2] linear = 0.466) and left striatum (R
2 linear = 0.510). Women presented a higher DAT-BP than men (women: R
2 linear = 0.431; men: R
2 linear = 0.457); nonetheless, their decrease by age group was equal to that in men.

Our study sheds light on important DAT-BP findings in healthy Brazilian subjects. Our results will facilitate understanding of brain illnesses that involve the dopamine system, such as neuropsychiatric disorders.
Serum CD5L predicts acute lung parenchymal injury and acute respiratory distress syndrome in trauma patients
Authors: Cheng Qian , Lai Xiaofei , Yang Liping , Yang Huiqing , Luo Yan
Published: October 2021

Cluster of differentiation 5 antigen-like (CD5L), derived from alveolar epithelial cells partly, is a secreted protein. It is shown that CD5L is associated with lung inflammation and systemic inflammatory diseases, but the relationship between CD5L and trauma-related acute lung parenchymal injury (PLI), acute lung injury or acute respiratory distress syndrome (ARDS) is unclear. This study aims to explore the value of serum CD5L levels in predicting trauma-associated PLI/ARDS and its potential clinical significance.

This is a prospective observational study, and a total of 127 trauma patients were recruited from the emergency department (ED), and among them, 81 suffered from PLI/ARDS within 24 hours after trauma, and 46 suffered from trauma without PLI/ARDS. Fifty healthy subjects from the medical examination center were also recruited as controls for comparison. The serum CD5L level was measured within 24 hours of admission. The receiver operating characteristic analysis and logistic regression analysis were used to identify the correlation between high CD5L and trauma associated-PLI/ARDS within 24 hours following trauma.

The trauma associated-PLI/ARDS subjects showed a significantly higher level of serum CD5L on emergency department admission within 24 hours after trauma compared with its level in non-trauma associated-PLI/ARDS subjects and healthy subjects. The initial CD5L concentration higher than 150.3 ng/mL was identified as indicating a high risk of PLI/ARDS within 24 hours following trauma (95% confidence interval: 0.674–0.878; P < .001). Moreover, CD5L was an independent risk factor for trauma associated-PLI/ARDS within 24 hours following trauma.

CD5L could predict PLI/ARDS within 24 hours following trauma.
Construction and comprehensive analysis of a competitive endogenous RNA network to reveal potential biomarkers for the malignant differentiation of glioma
Authors: Li Xin , Zhang Jingwen , Zhang Min , Qi Xianghua , Wang Shiyuan , Teng Jing
Published: October 2021

Background:

Long noncoding RNAs (lncRNAs) can act as microRNA (miRNA) sponges to regulate protein-coding gene expression; therefore, lncRNAs are considered major components of the competitive endogenous RNA (ceRNA) network and have attracted growing attention. This study explored the regulatory mechanisms and functional roles of lncRNAs as ceRNAs in the malignant differentiation of low-grade glioma (LGG) to glioblastoma (GBM) and their potential impact on the prognosis of patients with GBM.

Methods:

LncRNA and messenger RNA (mRNA) data were extracted from the Cancer Genome Atlas (TCGA) database from 156 GBM samples and 529 LGG samples. Separately, the miRNA expression data were downloaded from the Gene Expression Omnibus database, with the GSE112009 dataset containing miRNA expression data from 10 GBM samples and 15 LGG samples. Weighted gene coexpression network analysis was performed to screen the glioma grade-related lncRNAs. Then, a ceRNA network was established. The database for annotation, visualization, and integrated discovery was adopted to conduct functional enrichment analysis based on 57 upregulated differentially expressed mRNAs in the ceRNA network. Finally, Kaplan–Meier curves were created for the survival analysis of 13 hub lncRNA by combining the clinical data of GBM patients in TCGA.

Results:

A ceRNA network including 16 lncRNAs, 18 miRNAs, and 78 mRNAs specific to the malignant differentiation of LGG to GBM was established. The 57 upregulated differentially expressed mRNAs in the ceRNA network were significantly enriched in 35 gene ontology terms and 5 pathways. The survival analysis showed that 2 lncRNAs (LINC00261 and HOXA10-AS) were prognostic biomarkers for patients with GBM in TCGA.

Conclusion:

The proposed ceRNA network may help elucidate the regulatory mechanism by which lncRNAs function as ceRNAs and contribute to the malignant differentiation of LGG to GBM. Importantly, the candidate lncRNAs, miRNAs, and mRNAs involved in the ceRNA network can be further evaluated as potential therapeutic targets and prognostic biomarkers for GBM.
The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life
Authors: Gou Yanyun , Lei Huangwei , Zeng Yi , Tao Jing , Kong Weicheng , Wu Jingsong
Published: October 2021

Background:

It remains unclear if Pilates is conducive to reducing spinal deformity and improving patients’ quality of life (QOL) with scoliosis. The aim of this study was to systematically review the published evidence to determine whether Pilates exercise training is an efficacious therapy for scoliosis.

Methods:

Searches was conducted in Medline, Embase, PubMed, Scopus, CINAHL, Physiotherapy Evidence Database (PEDro), Cochrane library, Baidu Scholar, and Green Medical to identify randomized studies that tested the effect of Pilates exercise training on Cobb angle, pain level, trunk range of motion (ROM), angle of trunk rotation, and QOL in idiopathic scoliosis. Separate meta-analyses were performed on the endpoints of these outcome measures. The PEDro scale was used to assess the methodological quality of the included studies.

Results:

This review included 10 randomized controlled trials (n = 359). PEDro scores ranged from 3 to 10, with the mean score across all articles being 5.3/10 and judged to be of fair quality. The results indicated that Pilates exercises was effective in reducing Cobb angle (standardized mean difference [SMD] = 1.23, 95% confidence interval [CI] = 0.11–2.35), angle of trunk rotation (SMD = 1.37, 95% CI = 1.01–1.73), and pain level (SMD = 2.78, 95% CI = 1.55–4.01), as well as improving trunk ROM (SMD = 1.23, 95% CI = 0.45–2.00), and QOL (SMD = 3.05, 95% CI = 2.59–3.51) in patients with scoliosis.

Conclusion:

Pilates exercise training may reduce the Cobb angle and trunk rotation, relieve pain, increase trunk ROM, and improve QOL for patients with scoliosis. Due to the poor quality of the evidence, however, these results should be interpreted with caution.
Gastric metastasis and transformation of primary lung adenocarcinoma to small cell cancer after acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors
Authors: Liu Jing , Xia Lei , Peng Yuan , Huang Yu Sheng , Yang Zhen Zhou
Published: October 2021

Rationale:

Transformation to small cell lung cancer (SCLC) is one of the mechanisms of resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). However, no standard treatment is available after the transformation. In addition, gastric metastasis of primary lung cancer is rarely observed; thus, little is known about its metastatic characteristics.

Patient concerns:

A 58-year-old male patient was treated with gefitinib (0.25 g /day) as the 1st line treatment due of recurrence after surgical resection for EGFR exon 19 mutation pulmonary adenocarcinoma. However, he experienced recurrence with positive T790 M, and osimertinib (80 mg/day) was administered as the 2nd line therapy.

Diagnosis:

One year and 6 months after osimertinib initiation, he complained of stomachache, and a diagnostic gastroscopy biopsy confirmed small cell lung cancer in the gastric body, indicating osimertinib-induced phenotypic transformation.

Interventions and outcomes:

The patient was treated with etoposide and platinum chemotherapy and maintenance therapy with osimertinib. Finally, the patient achieved a partial response after 4 cycles.

Lessons:

Timely second biopsies should be considered in the diagnosis of phenotypic transformation. After transformation, chemotherapeutic treatment with etoposide and platinum and maintenance therapy with osimertinib inhibited the progression of the disease.
A case report about eosinophilic enteritis presenting as abdominal pain
Authors: Zhang Hairong , Ma Cuimei , Xue Yuan , Hu Zongjing , Xu Zhen , Wang Yibo , Zhou Guangxi
Published: October 2021

Rationale:

Eosinophilic enteritis (EE) is an immune-mediated antigen-driven disease that may lead to clinical symptoms and organ dysfunction and characterized by the presence of extensive eosinophilic infiltrates on histopathological examination of the intestinal mucosa.

Patient concerns:

A 29-year-old man presented with a half-month duration of paroxysmal upper abdominal pain that gradually evolved into continuous pain accompanied by the urge to defecate.

Diagnoses:

Pathological findings of enteroscopy showed acute and chronic inflammation accompanied by eosinophilic infiltration (>20/ high-power field).

Interventions:

The patient was initially treated with IV infusion of dexamethasone 10 mg per day for 3 days, which was reduced to 7.5 mg per day for 2 days once pain relief was achieved. Upon discharged from our hospital, the patient was prescribed with oral prednisolone 30 mg per day, which was reduced by 5 mg per week for 6 weeks until discontinuation.

Outcomes:

The patient was relieved from the pain after receiving dexamethasone for 5 days, and he was maintained on oral prednisolone 30 mg per day upon discharge from the hospital. On the day of discharge, the eosinophil count and derived ratios were normal.

Lessons:

In patients with EE, the dynamic changes of the eosinophil count should be monitored. Clinicians must be aware that not all patients with EE have a history of allergies. In the management and treatment of the disease, multisite biopsies should be carried out if EE is suspected, and EE is responsive to steroid therapy.
The correlation between FeNO and nNO in allergic rhinitis and bronchial asthma
Authors: Li Yi-Han , Yu Chen-Jie , Qian Xiao-Yun , Song Pan-Pan , Gao Xia
Published: October 2021

This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in allergic rhinitis (AR) and patients with or without bronchial asthma (BA).

A total of 90 patients who were diagnosed with persistent AR (AR group, n = 30), BA (BA group, n = 30), or allergic rhinitis with bronchial asthma (AR-BA) (AR-BA group, n = 30), were enrolled in this study, along with 30 healthy adult volunteers (control group, n = 30). The participants were further divided into 2 groups based on the results of a skin-prick test (SPT): a highly atopic group (SPT = 3+ and above) and a moderately atopic group (SPT = 2+ and below). All participants underwent FeNO and nNO measurement, an absolute blood eosinophil count, total serum immunoglobulin measurement, and horizontal baseline lung capacity determination.

The results showed that the FeNO levels in the 3 observation groups were significantly higher than those in the control group (P < .01), and in the BA group they were significantly higher than in the AR-BA group (P < .01). The levels of nNO in both the AR group and the AR-BA group were higher than those in the control group and the BA group (P < .01), but there was no significant difference between the AR group and the AR-BA group (P > .05). The levels of nNO in the BA group were also significantly different from those in the control group (P < .01).

FeNO and nNO are positively correlated with the degree of AR in patients with BA; therefore, nNO levels can be used as an inflammatory marker of AR in patients with BA. FeNO can also be used as an inflammatory marker of AR in patients complicated with BA as a warning indicator of asthma.
High cortisol and the risk of Alzheimer disease
Authors: Yao Zhuang , Liu Bin , Wang Yueyang , Dong Xiaohong
Published: October 2021

Background:

Morning cortisol levels have been reported to be elevated among patients with Alzheimer disease (AD). We perform a protocol for systematic review and meta-analysis to assess morning central or peripheral cortisol levels in AD patients as compared with cognitively normal individuals.

Methods:

Studies were identified through systematic searches in August 2021 with no restrictions on date and time, language, and publication status using the following bibliographic databases: Embase, Medline, PubMed, Web of Science, Science Direct, and the Cochrane Library. Studies were identified using search terms related to cortisol, Alzheimer disease, and cognitive impairment. The study quality of included papers was evaluated using the “National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies.” Statistical analyses were performed using Stata (version 14, StataCorp, College Station, TX).

Results:

The findings of this study will be submitted to peer-reviewed journals for publication.

Conclusion:

Morning cortisol was elevated in AD patients and may have diagnostic and prognostic values for AD.
Effect of anti-vascular endothelial growth factor on the surgical outcome of neovascular glaucoma
Authors: Hwang Hyung Bin , Lee Na Young
Published: October 2021

Background:

Bevacizumab is known to be very effective in inhibiting ocular neovascularization in neovascular glaucoma (NVG). The purpose of this study is to evaluate the effect of anti-vascular endothelial growth factor on the surgical outcome of Ahmed glaucoma valve implantation (AGVI) in NVG.

Methods:

An extensive search of PubMed, EMBASE, and the Cochrane Library was carried out in January 2021 to select relevant studies. The weighted mean difference of the intraocular pressure reduction percentage from baseline to endpoint was used for the primary efficacy estimate. Mantel–Haenszel odds ratios and 95% confidence intervals (CIs) for success rate were employed as secondary efficacy estimates. The number of postoperative interventions and the tolerability estimate for adverse events were also measured using odds ratios. We conducted meta-analyses of fixed effects models using comprehensive meta-analysis software to pool the results of the included studies. Heterogeneity was assessed using Q-value and I2 measures.

Results:

Nine studies were included in the analysis, encompassing a total of 410 eyes. There was no significant difference in intraocular pressure reduction percentage between the AGVI-only group and the AGVI with adjuvant bevacizumab group (estimate 0.324; 95% CI, −0.278-0.926; P = .244). However, the success rate favored the AGVI with adjuvant bevacizumab group (estimate 0.561; 95% CI, 0.097-1.025, P = .018).

Conclusions:

AGVI with adjuvant bevacizumab had no significant effect on lowering IOP in patients with neovascular glaucoma compared with AGVI alone. However, the final success rate was higher for AGVI with adjuvant bevacizumab treatment than with AGVI alone.
Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia
Authors: Charles-Lozoya Sergio , Cobos-Aguilar Héctor , Manilla-Muñoz Edgar , De La Parra-Márquez Miguel Leonardo , García-Hernández Adrián , Rangel-Valenzuela Jesús Mario
Published: October 2021

The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.

Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.

Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3–13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0–6.5, P < .001).

Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.
Dysregulated expression of circular RNAs serve as diagnostic and prognostic markers in ovarian and cervical cancer
Authors: Liu Fengyuan , Wu Xinrui , Zhu Huixia , Wang Feng
Published: October 2021

Introduction:

Recent studies have reported a connection between non-coding RNAs such as circular RNAs (circRNAs) and the prognosis of various cancers. However, the mechanism of circRNA in ovarian cancer and cervical cancer has not been consistent. We evaluated the diagnostic and prognostic roles of circRNAs in ovarian and cervical cancer by meta-analysis.

Methods:

Pooled hazard ratios with 95% confidence intervals were to estimate overall survival. Diagnostic efficacy was estimated by sensitivity, specificity and area under curve.

Results:

By searching PubMed, Embase, the Web of Science databases, and other sources, we obtained a total of 22 studies with 2059 patients from Asia population. High expression levels of oncogenic circRNAs were significantly associated with poor prognoses both in ovarian and cervical cancer. However, elevated expression levels of tumor-suppressor circRNAs were linked with favorable survival time in ovarian cancer. As for diagnostic role, the area under the curve value in ovarian cancer and cervical cancer is 0.89 and 0.93, respectively.

Conclusions:

CircRNAs have the prospect of becoming a promising biomarker for diagnosis and prognosis of ovarian and cervical cancer. Accordingly, circRNAs might be novel indicators and targets of therapy for ovarian and cervical cancer.
Cancer death and potential years of life lost in Feicheng City, China
Authors: Yang Jia , Zhao Li , Zhang Nan , Du Zhenhua , Li Yanyan , Li Xia , Zhao Deli , Wang Jialin
Published: October 2021

This study aimed to evaluate the impact of cancer-related mortality on life expectancy in Feicheng City.

We extracted the death records and population data of Feicheng City from 2013 to 2018 through the Feicheng Center for Disease Control and Prevention. The mortality, premature mortality, cause-eliminated life expectancy, potential years of life lost (PYLL), average potential years of life lost (APYLL), annual change percentage (APC), and other indicators of cancer were calculated. The age-standardized rates were calculated using the sixth national census (2010).

From 2013 to 2018, the mortality rate of cancer in Feicheng City was 221.55/100,000, and the standardized mortality rate was 166.37/100,000. The standardized mortality rate increased from 2013 to 2014 and then decreased annually. The premature mortality of cancer was 8.98% and showed a downward trend (APC = −2.47%, t = −3.10, P = .04). From 2013 to 2018, the average life expectancy of residents in Feicheng City was 78.63 years. Eliminating the impact of cancer, life expectancy could increase by 3.72 years. The rate of life loss caused by cancer in men was higher than that in women. The total life loss caused by cancer deaths was 126,870.50 person-years, the potential life loss rate was 22.51‰, and the average potential life loss was 13.30 years. The standardized potential years of life lost rate showed a downward trend (APC = −2.96%, t = −3.72, P = .02), and APYLL decreased by 1.98% annually (t = −5.44, P = .01). The top 5 malignant tumors in APYLL were leukemia, breast cancer, brain tumor, liver cancer, and ovarian cancer.

Lung cancer, esophageal cancer, female breast cancer, and childhood leukemia have a great impact on the life expectancy of residents in Feicheng City. Effective measures need to be taken to reduce the disease burden of malignant tumors.
Identification and validation of a hypoxia-related prognostic signature in clear cell renal cell carcinoma patients
Authors: Li Zhengtian , Du Gang , Zhao Rong , Yang Wenkang , Li Chan , Huang Jun , Wen Zhenpei , Li Hening , Zhang Bo
Published: October 2021

Increasing evidence has shown that hypoxia is closely related to the development, progression, and prognosis of clear cell renal cell carcinoma (ccRCC). Nevertheless, reliable prognostic signatures based on hypoxia have not been well-established. This study aimed to establish a hypoxia-related prognostic signature and construct an optimized nomogram for patients with ccRCC.

We accessed hallmark gene sets of hypoxia, including 200 genes, and an original RNA seq dataset of ccRCC cases with integrated clinical information obtained by mining the Cancer Genome Atlas database and the International Cancer Genome Consortium (ICGC) database. Univariate Cox regression analysis and multivariate Cox proportional hazards regression were performed to identify prognostic hub genes and further established prognostic model as well as visualized the nomogram. External validation of the optimized nomogram was performed in independent cohorts from the ICGC database.

ANKZF1, ETS1, PLAUR, SERPINE1, FBP1, and PFKP were selected as prognostic hypoxia-related hub genes, and the prognostic model effectively distinguishes high-risk and low-risk patients with ccRCC. The results of receiver operating characteristic curve, risk plots, survival analysis, and independent analysis suggested that RiskScore was a useful tool and independent predictive factor. A novel prognosis nomogram optimized via RiskScore showed its promising performance in both the Cancer Genome Atlas-ccRCC cohort and an ICGC-ccRCC cohort.

Our study reveals that the differential expressions of hypoxia-related genes are associated with the overall survival of patients with ccRCC. The prognostic model we established showed a good predictive and discerning ability in ccRCC patients. The novel nomogram optimized via RiskScore exhibited a promising predictive ability. It may be able to serve as a visualized tool for guiding clinical decisions and selecting effective individualized treatments.
Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture
Authors: Chiu Yung-Cheng , Hsu Cheng-En , Ho Tsung-Yu , Ting Yen-Nien , Wei Bor-Han , Tsai Ming-Tzu , Hsu Jui-Ting
Published: October 2021

Metacarpal shaft fractures are common hand fractures. Although bone plates possess strong fixation ability, they have several limitations. The use of headless compression screws for fracture repair has been reported, but their fixation ability has not been understood clearly.

This study aimed to compare the fixation ability of locked plate with that of headless compression screw for metacarpal fracture repair.

A total of 14 artificial metacarpal bones (Sawbones, Vashon, WA, USA) were subjected to transverse metacarpal shaft fractures and divided into 2 groups. The first group of bones was fixed using locked plates (LP group), whereas the second group was fixed using headless compression screws (HC group). A material testing machine was used to perform cantilever bending tests, whereby maximum fracture force and stiffness were measured. The fixation methods were compared by conducting a Mann–Whitney U test.

The maximum fracture force of the HC group (285.6 ± 57.3 N, median + interquartile range) was significantly higher than that of the LP group (227.8 ± 37.5 N; P < .05). The median of the HC group was 25.4% greater. However, no significant difference in stiffness (P > .05) was observed between the HC (65.2 ± 24.6 N/mm) and LP (61.7 ± 19.7 N/mm) groups.

Headless compression screws exhibited greater fixability than did locked plates, particularly in its resistance to maximum fracture force.
Application of loop-mediated isothermal amplification and next-generation sequencing in the diagnosis of maternal tuberculosis with multiple negative tests
Authors: Li Hongwei , Wu Qian , Hu Jinmiao , Feng Liting , Wu Qi , Yu Hongzhi , Li Li , Li Xinhui
Published: October 2021

Rationale:

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is the leading infectious cause of death. The incidence of TB, especially active TB, is increased in pregnant and postpartum women. Newborns can be infected with TB from their mothers through several routes. Diagnosis of TB in pregnant women and infants is difficult. Here, we report the simultaneous postdelivery diagnosis of TB in a mother and infant pair.

Patient concerns:

A 28-year-old woman presented with a sudden onset of convulsions, loss of consciousness, coughing, fever, and breathing difficulty. Her 18-day-old infant daughter developed cough and wheezing.

Diagnosis:

The mother's chest computed tomography showed diffuse interstitial changes and both lungs’ exudation. Enhanced cranial magnetic resonance imaging showed scattered nodular intracranial lesions. A tuberculin skin test and an interferon-gamma release assay were negative. Xpert MTB/RIF (Xpert) testing and acid-fast bacilli smear of bronchoalveolar lavage (BAL) fluid of the mother were negative. Loop-mediated isothermal amplification of BAL fluid was positive for Mycobacterium tuberculosis, and next-generation sequencing confirmed the diagnosis of TB. A biopsy specimen also showed characteristic TB findings. The mother was diagnosed with TB and TB encephalitis. The infant's BAL fluid was positive for acid-fast bacilli and Xpert and, therefore, was diagnosed with TB.

Interventions:

The mother was treated with rifampicin and isoniazid for 9 months, ethambutol and pyrazinamide for 3 months, and prednisolone acetate for 8 weeks. The infant received ventilator-assisted ventilation for 10 days and anti-tuberculous therapy for 11 months.

Outcomes:

After anti-tuberculous therapy, the mother and infant both gradually recovered. The mother's chest computed tomography showed significant recovery 9 months after discharge. The infant developed normally during the 11-month follow-up.

Lessons:

This mother-child case pair highlights the value of loop-mediated isothermal amplification and next-generation sequencing as new diagnostic technologies for diagnosing TB in patients with multiple negative tests.
Appendiceal carcinoid in a pediatric patient with Peutz-Jeghers syndrome
Authors: Zvizdic Zlatan , Milisic Emir , Ibisevic Nermina , Pasic Irmina Sefic , Vranic Semir
Published: October 2021

Rationale:

Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population.

Patient concerns:

We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted.

Diagnosis:

A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a “coffee bean” appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps.

Interventions:

An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed.

Outcomes:

Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences.

Lessons:

Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.
Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis
Authors: Lee In Hee , Cho Seong , Ahn Dong Jik , Kim Min-Kyung
Published: October 2021

Rationale:

Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolysis as the first manifestation. Herein, we report a case of SLE with lupus nephritis in a patient with acute hyponatremia-associated rhabdomyolysis.

Patient concerns:

A 44-year-old woman was admitted with complaints of altered consciousness, myalgia, and red-brownish urine that first appeared three days prior. Peripheral blood tests revealed elevated creatine kinase (19,013 IU/L) and myoglobin (5099 U/L) levels and severe hyponatremia (111 mEq/L) with no azotemia. Urinalysis showed nephritic sediments.

Diagnosis:

Whole-body bone scintigraphy showed increased uptake of radiotracer in the both upper and lower extremities. Serological evaluation revealed the presence of anti-nuclear (speckled pattern, 1:640), anti-double stranded DNA, and anti-Smith antibodies and absence of anti-Jo-1 antibody. A kidney biopsy demonstrated mesangial proliferative (class II) lupus nephritis.

Interventions:

Fluid therapy, including intravenous administration of 3% NaCl, was initiated. After three consecutive days of intravenous methylprednisolone (1 g/d), oral prednisolone (1 mg/kg/d), mycophenolate mofetil, and hydroxychloroquine were administered.

Outcomes:

On day 28, the patient was discharged with marked resolution of SLE-associated symptoms and laboratory findings. Lupus reactivation was not present during the subsequent six-month follow-up.

Lessons:

Hyponatremia-associated rhabdomyolysis can be the first manifestation of SLE. Moreover, prompt fluid therapy and timely administration of immunosuppressive agents in SLE patients presenting with hyponatremia and rhabdomyolysis can significantly help alleviate disease activity and improve clinical outcomes.
The elderly harbor greater proportions of advanced histology in subcentimeter adenomas: implications for screening colonoscopy approaches
Authors: Guo Shuang , Gu Jiaoyang , Zhang Dongdong , Wang Xiaoying , Li Shuai
Published: October 2021

Background

Screening and surveillance for colorectal cancer can reduce both the incidence of this disease and mortality rates attributed to it. Normally, surveillance intervals should be based on baseline colonoscopy findings, and clinicians focus on advanced polyps and perform patient risk stratification to devise surveillance schedules. The aim of the study was to determine differences in advanced colorectal polyp characteristics and consequent risk stratifications in patients of different age groups.

Material and methods

We retrospectively reviewed 14 312 patients during a 5-year period; a total of 13 842 polyps were stratified by their sizes, locations, and histologies. Participants were categorized into three age groups, the <45 years group, the 45–59 years group and the >59 years group, and each group was further stratified as normal, low risk, and high risk.

Results

The <45 years group included 2431 subjects, the 45–59 years group 6258 subjects, and the >59 years group 5623 subjects. The frequency of adenoma and advanced polyps in the proximal colon slightly increased with age. Only 1.0% in the <45 years and 1.3% in the 45–59 years groups of subcentimeter polyps were identified as advanced polyps, less than that in the >59 years group (2.1%). Most patients, especially the elderly, considered as high risk had multiple subcentimeter adenomas.

Conclusion

The processing strategy proposed for subcentimeter polyps in the elderly still needs to be further explored in the future. Clinicians should recognize the importance of performing a detailed scan of the entire colon.
Assessing and Augmenting Predictive Models for Hospital Readmissions With Novel Variables in an Urban Safety-net Population
Authors: Ryan Patrick , Furniss Anna , Breslin Kristin , Everhart Rachel , Hanratty Rebecca , Rice John
Published: October 2021

Background:

The performance of existing predictive models of readmissions, such as the LACE, LACE+, and Epic models, is not established in urban safety-net populations. We assessed previously validated predictive models of readmission performance in a socially complex, urban safety-net population, and if augmentation with additional variables such as the Area Deprivation Index, mental health diagnoses, and housing access improves prediction. Through the addition of new variables, we introduce the LACE-social determinants of health (SDH) model.

Methods:

This retrospective cohort study included adult admissions from July 1, 2016, to June 30, 2018, at a single urban safety-net health system, assessing the performance of the LACE, LACE+, and Epic models in predicting 30-day, unplanned rehospitalization. The LACE-SDH development is presented through logistic regression. Predictive model performance was compared using C-statistics.

Results:

A total of 16,540 patients met the inclusion criteria. Within the validation cohort (n=8314), the Epic model performed the best (C-statistic=0.71, P<0.05), compared with LACE-SDH (0.67), LACE (0.65), and LACE+ (0.61). The variables most associated with readmissions were (odds ratio, 95% confidence interval) against medical advice discharge (3.19, 2.28–4.45), mental health diagnosis (2.06, 1.72–2.47), and health care utilization (1.94, 1.47–2.55).

Conclusions:

The Epic model performed the best in our sample but requires the use of the Epic Electronic Health Record. The LACE-SDH performed significantly better than the LACE and LACE+ models when applied to a safety-net population, demonstrating the importance of accounting for socioeconomic stressors, mental health, and health care utilization in assessing readmission risk in urban safety-net patients.
Acquired Elastotic Hemangioma-like Change of the Vulva Associated With Lichen Sclerosus
Authors: Val-Bernal José-Fernando , Hermana Sandra , Aller Laura
Published: October 2021

Acquired elastotic hemangioma (AEH) is a rare variant of hemangioma that usually presents as an asymptomatic, solitary, slow-growing red plaque on a sun-exposed site of an adult. Ultraviolet radiation can contribute to the pathogenesis of this hemangioma. Lichen sclerosus (LS), a scarring disease, may present a prominent accumulation of elastic fibers in the reticular dermis reflecting a reparative process. Vulvar elastosis, a novel diagnostic entity with fibers similar to solar elastosis, is more common in women 45 yr and older and is related to aging and/or hormonal changes. We herein report for the first time a case of AEH-like change located in the vulva, a sun-protected area, associated with genital LS. An 81-yr-old woman presented with a painful vulvar lesion of 1-yr duration. Clinical examination revealed vulvar LS and 1 cm-flat, erythematous, well-defined plaque with increased consistency located on the left labium minus. Histopathology showed a non-neoplastic proliferation of WT1-positive, small vascular channels surrounded and intertwined by intense elastosis in the reticular dermis. Alpha-smooth muscle actin positive pericytes encircled the vascular channels. The lesion can be understood as a reparative process within an LS with the appearance of epidermal hyperplasia, proliferation of small vascular channels, and hyperplastic elastosis. There is a close link between epidermal hyperplasia and angiogenesis in the formation of this reparative lesion. Recognition of this lesion is crucial to avoid confusion with other significant processes especially Kaposi sarcoma and well-differentiated angiosarcoma.
Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age
Authors: Attia Engi F. , Moraa Hellen , Maleche-Obimbo Elizabeth , Wamalwa Dalton , Gómez Laurén A. , Rylance Sarah , Vundla Rumbidzayi , Ferrand Rashida A. , Karr Catherine J. , John-Stewart Grace C. , Benki-Nugent Sarah F.
Published: October 2021

Background:

Impaired lung function is common among older children with perinatally acquired HIV (PHIV) who initiated antiretroviral therapy (ART) late in childhood. We determined the prevalence of abnormal spirometry and cofactors for impaired lung function among school-age children with PHIV who initiated ART when aged 12 months or younger.

Setting:

Children who received early ART in the Optimizing Pediatric HIV-1 Therapy study in Kenya and underwent spirometry at school age.

Methods:

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured. Abnormal spirometry was defined as follows: obstructive (FEV1/FVC <1.64 z score [zFEV1/FVC]) and restricted (zFVC <1.64 with zFEV1/FVC ≥1.64). Characteristics, including anthropometric and HIV-related data, were ascertained in infancy and at school age. Caregiver carbon monoxide exposure served as a proxy for school-age child exposure. Linear regression determined associations of cofactors with lung function.

Results:

Among 40 children, the median age was 5 months at ART initiation and 8.5 years at spirometry. The mean zFEV1, zFVC, and zFEV1/FVC (SD) were 0.21 (1.35), 0.31 (1.22), and −0.24 (0.82), respectively. Five (13%) children had abnormal spirometry. Spirometry z scores were significantly lower among children with pre-ART pneumonia, WHO HIV stage 3/4, higher HIV RNA at 6 months after ART initiation, low anthropometric z scores, and higher carbon monoxide exposure.

Conclusions:

Most of the children with PHIV who initiated ART at age 12 months or younger had normal spirometry, suggesting that ART in infancy preserved lung function. However, 13% had abnormal spirometry despite early ART. Modifiable factors were associated with impaired lung function, providing potential targets for interventions to prevent chronic lung disease.
Atypical Young-onset Dementia in Cerebral Thromboangiitis Obliterans
Authors: Kim Eun-Joo , Jung Na-Yeon , Lee Myung Jun , Pak Kyoungjune , Lee Jae-Hyeok , Lee Young Min , Shin Jin-Hong , Ko Jun Kyeung , Lee Jae Meen , Yoon Jin A. , Hwang Chungsu , Choi Kyung-Un , Huang Eric J. , Huh Gi Yeong
Published: October 2021

Young-onset dementia (YOD, age at onset below 45 y) has a broad differential diagnosis. We describe a 41-year-old man with atypical manifestations of YOD syndrome in cerebral thromoboangiitis obliterans (CTAO). Extensive antemortem workup including clinical assessment, laboratory investigations, neuroimaging, and genetic testing did not elucidate a diagnosis. Postmortem neuropathologic examination revealed cortical sickle-shaped granular atrophy, resulting from numerous remote infarcts and cortical microinfarcts that mainly affected the bilateral frontal and parietal lobe, confirming CTAO. Although CTAO is a rare cause of vascular dementia, it should be considered as one of the differentials in patients with YOD with a history of heavy smoking and presence of symmetric damages of watershed-territory on neuroimaging.