bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of an educational intervention for rational cardiac enzyme requisitions in critically ill patients: a pre–post intervention study
Authors: Tedesco Natália sarracceni , Pinheiro Frederico Augusto Gurgel , Vieira Júnior José mauro , Taniguchi Leandro Utino
Published: October 2022

Background

Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase–myocardial band (CK-MB) tests where troponin is available.

Objective

The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit.

Method

We conducted a quasi-experimental, pre–post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two 12-month periods: pre-intervention (September 2017–August 2018) and post-intervention (October 2018–September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in CK-MB and troponin testing.

Results

We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of CK-MB and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of CK-MB with troponin after the intervention (−0.13 tests per patient, P = 0.0016) but not in the secular trend for the concomitance. The proportion of patients with the acute coronary syndrome as a discharge diagnosis was not different between the pre- and post-intervention period.

Conclusion

Our pre–post interventional study demonstrated a significant decrease in the concomitance of CK-MB and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions.
Exploring dust growth in the episodic WCd system WR140
Authors: Eatson J W , Pittard J M , Van Loo S
Published: October 2022

The wind collision region (WCR) in a colliding wind binary (CWB) is a particularly violent place, as such, it is surprising that it is also a region where significant quantities of interstellar dust can form. In extreme cases, approximately 30 per cent of the total mass-loss rate of a system can be converted into dust. These regions are poorly understood, as observation and simulation of these systems are difficult. In our previous paper, we simulated dust growth in CWB systems using an advected scalar model and found our model to be suitable for qualitative study. For this paper, we simulated the periodic dust forming CWB (WCd) system WR140 with our dust model, to determine how dust growth changes over the systems periastron passage. We found that dust production increases significantly at periastron passage, which is consistent with IR emission of the surrounding dusty shell. We also find that the dust production rate of the system decreases rapidly as the stars recede from each other, though the rate of decrease is significantly lower than the rate of increase during periastron passage. This was found to be due to strong cooling and its associated thermal instabilities, resulting in cool, high-density pockets of gas in the WCR where dust forms. The WCR also shows a degree of hysteresis, resulting in a radiative post-shock flow even when the stars are separated enough for the region to behave adiabatically.
Management of snake bite during third trimester of pregnancy with coagulopathy and delivery of a live baby in resource-limited setting in Nepal: a case report
Authors: Gupta Ashwini , Bhandari Sudeep , Anand Ayush , Sharma Sanjib Kumar , Gautam Arun , Priyanka K C , Acharya Neeraj , Singh Sweta
Published: October 2022

We reported a case of snakebite in an 18-year-old woman, Gravida 2 Para 1+0 in the third trimester of pregnancy who presented with pain and swelling over the left hand and forearm and vaginal spotting. The laboratory investigations revealed coagulopathy attributed to green pit viper envenomation. On the fourth day of admission, the patient developed sudden abdominal pain and massive per vaginal bleeding with haemorrhagic shock, most likely abruptio placentae. In Nepal, no anti-snake venom has been developed for green pit-viper. So, she was managed conservatively, including blood transfusion, and delivered a single live female baby without any foetal complications. The patient was discharged along with the baby after 8 days of hospitalization. This case demonstrated that vigilant observation and appropriate resuscitation with fluids and blood products could save mother and baby in pit viper envenomation cases in settings where specific anti-snake venom is unavailable.
In-stent restenosis of superficial femoral artery: use all arrows in the quiver
Authors: Vadalà Giuseppe , Ceresa Fabrizio , Costa Francesco , Bottari Antonio , Roscitano Giuseppe , Patanè Francesco , Micari Antonio
Published: October 2022

In-stent restenosis (ISR) is a common superficial femoral artery (SFA) stenting complication, occurring in more than one third of patients within 2–3 years after the index procedure. Moreover, there is no standard treatment for ISR, and although many options are available, there is still limited data regarding its optimal management. We report a paradigmatic case report of a patient complaining of symptomatic peripheral arterial disease, underwent multiple endovascular revascularizations for recurrent femoro-popliteal ISR. A step-by-step approach was followed. At the time of the first presentation, the ISR was treated by drug-eluting balloon (DEB) angioplasty. The repeated ISR was treated by laser debulking, achieving a good angiographic result. Finally, after the third repeated restenosis, a combined approach with laser debulking and DEB angioplasty guaranteed a good acute angiographic result. Long-term duplex-scan follow-up demonstrated the good patency of the femoro-popliteal target lesion.
Mass matrices with CP phase in modular flavor symmetry
Authors: Kikuchi Shota , Kobayashi Tatsuo , Tanimoto Morimitsu , Uchida Hikaru
Published: October 2022

We study the CP violation and the CP phase of quark mass matrices in modular flavor symmetric models. The CP symmetry remains at τ = e2πi/3 by a combination of the T-symmetry of the modular symmetry. However, T-symmetry breaking may lead to CP violation at the fixed point τ = e2πi/3. We study such a possibility in magnetized orbifold models as examples of modular flavor symmetric models. These models, in general, have more than one candidate for Higgs modes, while generic string compactifications also lead to several Higgs modes. These Higgs modes have different behaviors under the T-transformation. The light Higgs mode can be a linear combination of those modes so as to lead to realistic quark mass matrices. The CP phase of the mass matrix does not appear in a certain case, which is determined by the T-transformation behavior. Deviation from this is important to realize the physical CP phase. We discuss an example leading to a non-vanishing CP phase at the fixed point τ = e2πi/3.
External Jugular Venous Aneurysm: A Case Report
Authors: Nakajima Yuki , Murata Mai , Shudo Kana , Yoshikawa Katsuhiro
Published: October 2022

Venous aneurysms of the external jugular vein (EJV) are exceedingly rare. During the 21-year period from 2000 to 2020, only 30 cases were reported. There have been no reports of serious complications associated with EJV aneurysms. Treatment is mainly for cosmetic reasons, but sometimes for pain or other symptoms. Currently, surgical excision is the most commonly applied therapeutic strategy. In this report, we present the case of a 40-year-old previously healthy woman who presented with a painful mass in her left supraclavicular area after a mild left neck contusion injury one month earlier. A venous aneurysm of the left EJV was diagnosed on the basis of vascular ultrasound and computed tomography angiography and venography findings. The patient underwent surgical removal of the EJV aneurysm for the symptom of pain. The EJV was repaired and preserved based on the intraoperative findings. The treatment resulted in cosmetic improvement and pain relief, with no signs of recurrence.
The T-type calcium channel CaV3.2 regulates bladder afferent responses to mechanical stimuli
Authors: Grundy Luke , Tay Cindy , Christie Stewart , Harrington Andrea M. , Castro Joel , Cardoso Fernanda C. , Lewis Richard J. , Zagorodnyuk Vladimir , Brierley Stuart M.
Published: October 2022

The bladder wall is innervated by a complex network of afferent nerves that detect bladder stretch during filling. Sensory signals, generated in response to distension, are relayed to the spinal cord and brain to evoke physiological and painful sensations and regulate urine storage and voiding. Hyperexcitability of these sensory pathways is a key component in the development of chronic bladder hypersensitivity disorders including interstitial cystitis/bladder pain syndrome and overactive bladder syndrome. Despite this, the full array of ion channels that regulate bladder afferent responses to mechanical stimuli have yet to be determined. Here, we investigated the role of low-voltage-activated T-type calcium (CaV3) channels in regulating bladder afferent responses to distension. Using single-cell reverse-transcription polymerase chain reaction and immunofluorescence, we revealed ubiquitous expression of CaV3.2, but not CaV3.1 or CaV3.3, in individual bladder-innervating dorsal root ganglia neurons. Pharmacological inhibition of CaV3.2 with TTA-A2 and ABT-639, selective blockers of T-type calcium channels, dose-dependently attenuated ex-vivo bladder afferent responses to distension in the absence of changes to muscle compliance. Further evaluation revealed that CaV3.2 blockers significantly inhibited both low- and high-threshold afferents, decreasing peak responses to distension, and delayed activation thresholds, thereby attenuating bladder afferent responses to both physiological and noxious distension. Nocifensive visceromotor responses to noxious bladder distension in vivo were also significantly reduced by inhibition of CaV3 with TTA-A2. Together, these data provide evidence of a major role for CaV3.2 in regulating bladder afferent responses to bladder distension and nociceptive signalling to the spinal cord.
The Need for Non-profit Psychiatric Drug Discovery and Development
Authors: Ghaemi S. Nassir
Published: October 2022

Background

Current psychiatric drug discovery and development has not produced very effective medications in the past few decades. Conventional wisdom provides reasons for failure that do not address major structural obstacles to true innovation for psychiatric drugs.

Method

Narrative review based on analysis of the scientific literature augmented by personal experience in academic clinical research as well as in the pharmaceutical industry.

Results

The largest obstacles to drug discovery and development are the biological invalidity of most DSM diagnoses, the economic incentives to produce short-term symptomatic treatments with blockbuster profit potential, and very low thresholds set by the FDA for ending drug discovery due to toxicity. Since these larger structural socio-economic obstacles to drug development will be difficult to change, a new proposal is made for a parallel non-profit drug discovery paradigm, to be funded by governments, akin to the development of vaccines for the Covid-19 pandemic. The key public health implications are highlighted in the example of developing new drugs for Alzheimer dementia, and the potential utility of an anti-tau agent like lithium, currently ignored in drug development in favor of much more expensive and questionably effective amyloid-reducing agents.

Conclusions

Given the key structural problems of psychiatric drug discovery and development, a parallel non-profit drug discovery paradigm is needed to meet all public health needs, as well as to reinvigorate truly innovative and transformative research.
Long-acting drugs: people’s expectations and physicians’ preparedness. Are we readying to manage it? An Italian survey
Authors: Celesia Marta , Moscatt Vittoria , Tzannis Alessandra , Trezzi Michele , Focà Emanuele , Errico Margherita , Cinque Paola , Nozza Silvia , Cingolani Antonella , Ceccarelli Manuela , Celesia Benedetto M.
Published: October 2022

To evaluate patients’ expectations regarding long-acting antiretroviral agents and preferences about where to receive them. Multicenter cross-sectional survey-based study. Through an online survey, we asked people living with human immunodeficiency virus to judge their relationship with daily antiretroviral therapy (ART) and to give their opinion about long-acting drugs. We also collected data regarding the age of the patients, their site of follow-up, time since the diagnosis, and compliance to ART. Two hundred forty-two patients aged 18 to 79 years were included in the study: 58 (24%) females, 182 (75.2%) males, and 2 (0.8%) male-to-female transgenders. 81.8% of the said population had a good relationship with ART. 33.6% of them consider daily ART an obligation and a restriction to their freedom. One hundred forty-three (59.1%) patients already knew about long-acting drugs before our interview, and 215 (88.8%) patients were interested in it. One hundred fifty-six (64.4%) interviewees said they would still be interested in hospital-available injective long-acting drugs, although 57.9% of the patients would rather receive them at home. The data emerging from our survey reveal that around 90% of the people living with HIV are interested in changing their actual treatment with a long-acting one. Moreover, for the first time to our knowledge, such a high number of patients showed an enthusiastic response to the new opportunity to be treated directly at home. The introduction of these new drugs could be revolutionary and represents an important step toward treatment simplification.
Mathematical models for intraoperative prediction of metastasis to regional lymph nodes in patients with clinical stage I non-small cell lung cancer
Authors: Zhou Yue , Du Junjie , Ma Changhui , Zhao Fei , Li Hai , Ping Guoqiang , Wang Wei , Luo Jinhua , Chen Liang , Zhang Kai , Zhang Shijiang
Published: October 2022

It remains challenging to determine the regions of metastasis to lymph nodes during operation for clinical stage I non-small cell lung cancer (NSCLC). This study aimed to establish intraoperative mathematical models with nomograms for predicting the hilar-intrapulmonary node metastasis (HNM) and the mediastinal node metastasis (MNM) in patients with clinical stage I NSCLC. The clinicopathological variables of 585 patients in a derivation cohort who underwent thoracoscopic lobectomy with complete lymph node dissection were retrospectively analyzed for their association with the HNM or the MNM. After analyzing the variables, we developed multivariable logistic models with nomograms to estimate the risk of lymph node metastasis in different regions. The predictive efficacy was then validated in a validation cohort of 418 patients. It was confirmed that carcinoembryonic antigen (>5.75 ng/mL), CYFRA211 (>2.85 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, and vascular invasion were predictors of HNM, and carcinoembryonic antigen (>8.25 ng/mL), CYFRA211 (>2.95 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, vascular invasion, and visceral pleural invasion were predictors of MNM. The validation of the prediction models based on the above results demonstrated good discriminatory power. Our predictive models are helpful in the decision-making process of specific therapeutic strategies for the regional lymph node metastasis in patients with clinical stage I NSCLC.
Association of the medical therapy with beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mildly reduced left ventricular ejection fraction after acute myocardial infarction
Authors: Joo Seung-Jae , Kim Song-Yi , Lee Jae-Geun , Beom Jong Wook , Choi Joon-Hyouk , Park Hyeung Keun , Boo Ki Yung , Yoon Chang-Hwan , Lee Jung-Hee , Chae Jei Keon , Jeong Myung Ho ,   on behalf of the KAMIR-NIH registry investigators
Published: October 2022

In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mildly reduced left ventricular ejection fraction (EF) (41%–49%) have been increasing. This observational study aimed to investigate the association between the medical therapy with oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mildly reduced EF after AMI. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health, propensity-score matched patients who survived the initial attack and had mildly reduced EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events which was a composite of cardiac death, myocardial infarction, revascularization and re-hospitalization due to heart failure (8.7 vs 12.8/100 patient-years; hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.50–0.93; P = .015), and no significant interaction between EF ≤ 45% and > 45% was observed (P
interaction = 0.354). This association was mainly driven by lower myocardial infarction in patients with beta-blockers (HR 0.50; 95% CI 0.26–0.95; P = .035). Inhibitors of RAS at discharge were associated with lower re-hospitalization due to heart failure (1.8 vs 3.5/100 patient-years; HR 0.53; 95% CI 0.33–0.86; P = .010) without a significant interaction between EF ≤ 45% and > 45% (P
interaction = 0.333). In patients with mildly reduced EF after AMI, the medical therapy with beta-blockers or RAS inhibitors at discharge was associated with better 2-year clinical outcomes.
A longitudinal evaluation on 3-year change of anxiety and depression, and their risk factors among parents of childhood and adolescence patients with resectable osteosarcoma: A cohort study
Authors: Meng Jie , Wu Jing , Zhang Xinying , Guo Libo , Li Honghe
Published: October 2022

Psychological disorders often occur among parents of children with cancer. The current study aimed to explore the longitudinal change of anxiety and depression and their related factors among parents of childhood and adolescence patients with osteosarcoma. A total of 56 childhood and adolescence patients with osteosarcoma who underwent tumor resection and corresponding 104 parents were enrolled. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and HADS-Depression (HADS-D) of parents were evaluated at baseline (the day of patients’ hospital discharge), 0.5 year, 1 year, 2 years, and 3 years. From baseline to the 3rd year, HADS-A (from 8.3 ± 3.1 to 9.4 ± 3.1. P < .001), HADS-D score (from 7.7 ± 3.2 to 8.8 ± 2.9, P = .001), anxiety rate (from 45.2% to 60.6%, P = .038), depression rate (from 38.5% to 57.7%, P = .002) were elevated; meanwhile, anxiety severity (P = .001) and depression severity (P = .001) were also increased. Furthermore, multivariate logistic regression analysis presented that the role of mother, divorced/widowed marital status, declined family annual income, elevated Enneking stage, and amputation were independently correlated with elevated risk of parents’ baseline anxiety or depression (all P < .05). Additionally, declined family annual income, elevated Enneking stage, and amputation were independently correlated with increased risk of parents’ 3-year anxiety or depression (all P < .05). Anxiety and depression deteriorate with time in parents of childhood and adolescence patients with osteosarcoma, which are affected by parental role, marital status, family annual income, surgery type, and Enneking stage.
IgA nephropathy with mimicking Fabry disease: A case report and literature review
Authors: Sun Liping , Zi Xinyi , Wang Zhen , Zhang Xinzhou
Published: October 2022

Background:

Fabry disease (FD) is a rare, inherited disease lysosomal storage disorder caused by the lack of an alpha-galactosidase enzyme. This genetic disease can affect both men and women. The understanding of FD is very important as this condition can be effectively treated. For women who may exhibit normal residual enzyme activity, the diagnosis is more challenging.

Case presentation:

Herein, we reported on a case of IgA nephropathy and renal disease that mimicked FD in a female patient. The presence of zebra bodies in the cytoplasm of glomerular podocytes is widely accepted as a hallmark pathological manifestation of FD. In the present case, renal biopsy analysis revealed the presence of zebra bodies; however, genetic testing indicated that the patient did not have FD. The mechanisms and causes of zebra body formation remained unclear in the present case. However, the patient responded well to treatment with an angiotensin receptor blocker.

Conclusions:

The reported findings can be useful for the differential diagnosis of FD and renal diseases in the future. Our results also highlight the clinical significance of zebra bodies in renal disease.
Diagnostic accuracy of gastric filling ultrasonography in preoperative invasion depth (T stage) of gastric cancer: Meta-analysis
Authors: Nan Mengmeng , Ye Weihua , Liu Yu , Zhang Zibo
Published: October 2022

Objective:

This study aimed to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth (T staging) of gastric cancer.

Methods:

We systematically searched several online electronic databases including CNKI, Wanfang Medical Database, VIP, CBM, Pubmed, Embase, Cochrane Library, and Web of Science from January 2010 to December 2021, identifying the study about gastric filling ultrasonography for diagnostic of invasion depth of gastric cancer. Using bivariate mixed effect model to calculate the sensitivity (Sen), specificity (spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with 95% confidence interval (CI). Draw the summary receiver operating characteristic (sROC) curve, likelihood ratio matrix and fagan diagram to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth of gastric cancer. Sen analysis and Publication bias tests were performed.

Results:

This study obtained 21 literatures and the quality were good. The pooled Sen and spe of gastric filling ultrasonography was: T1: 0.63 (95% CI:0.51–0.73), 0.96 (95% CI:0.94–0.98); T2: 0.67 (95% CI:0.62–0.71), 0.90 (95% CI:0.88–0.93); T3: 0.79 (95% CI:0.75–0.82), 0.83 (95% CI:0.80–0.86); T4: 0.80 (95% CI:0.73–0.86), 0.96 (95% CI:0.94–0.97), respectively. In addition, the PLR and NLR of gastric filling ultrasonography was: T1: 16.74 (95% CI:9.98–28.09), 0.39 (95% CI:0.29–0.52); T2: 6.98 (95% CI:5.20–9.38), 0.36 (95% CI:0.31–0.42); T3: 4.65 (95% CI:3.78–5.73), 0.26 (95% CI:0.21–0.31); T4: 18.51 (95% CI:12.77–26.83), 0.20 (95% CI: 0.15–0.29), respectively. The DOR of gastric filling ultrasonography in T1-T4 was: 43.17 (95% CI:20.62–90.41),19.13 (95% CI:12.61–29.03), 18.15 (95% CI:12.86–25.62), 90.63 (95% CI:47.36–173.41), respectively. The sROC curve revealed that the area under the curve (AUC) of T1-T4 was: 0.93, 0.82, 0.87, 0.97, respectively. Sen analysis indicated that the study was steadily. And there is no publication bias in this study. But the study has some heterogeneity.

Conclusion:

Gastric filling ultrasonography is useful for clinical preoperative T staging of gastric cancer, and the result indicate that the accuracy of gastric filling ultrasonography in discriminating T1-T4 is higher than that in discriminating T2 - T3. It can be used as an imaging diagnostic method for preoperative T staging of gastric cancer.
Construction and validation of a novel prognostic model for thyroid cancer based on N7-methylguanosine modification-related lncRNAs
Authors: Zhou Yang , Dai Xuezhong , Lyu Jianhong , Li Yingyue , Bao Xueyu , Deng Fang , Liu Kun , Cui Liming , Cheng Li
Published: October 2022

Background:

To construct and verify a novel prognostic model for thyroid cancer (THCA) based on N7-methylguanosine modification-related lncRNAs (m7G-lncRNAs) and their association with immune cell infiltration.

Methods:

In this study, we identified m7G-lncRNAs using co-expression analysis and performed differential expression analysis of m7G-lncRNAs between groups. We then constructed a THCA prognostic model, performed survival analysis and risk assessment for the THCA prognostic model, and performed independent prognostic analysis and receiver operating characteristic curve analyses to evaluate and validate the prognostic value of the model. Furthermore, analysis of the regulatory relationship between prognostic differentially expressed m7G-related lncRNAs (PDEm7G-lncRNAs) and mRNAs and correlation analysis of immune cells and risk scores in THCA patients were carried out.

Results:

We identified 29 N7-methylguanosine modification-related mRNAs and 116 differentially expressed m7G-related lncRNAs, including 87 downregulated and 29 upregulated lncRNAs. Next, we obtained 8 PDEm7G-lncRNAs. A final optimized model was constructed consisting of 5 PDEm7G-lncRNAs (DOCK9−DT, DPP4–DT, TMEM105, SMG7–AS1 and HMGA2–AS1). Six PDEm7G-lncRNAs (DOCK9–DT, DPP4–DT, HMGA2–AS1, LINC01976, MID1IP1–AS1, and SMG7–AS1) had positive regulatory relationships with 10 PDEm7G-mRNAs, while 2 PDEm7G-lncRNAs (LINC02026 and TMEM105) had negative regulatory relationships with 2 PDEm7G-mRNAs. Survival curves and risk assessment predicted the prognostic risk in both groups of patients with THCA. Forest maps and receiver operating characteristic curves were used to evaluate and validate the prognostic value of the model. Finally, we demonstrated a correlation between different immune cells and risk scores.

Conclusion:

Our results will help identify high-risk or low-risk patients with THCA and facilitate early prediction and clinical intervention in patients with high risk and poor prognosis.
Comparison of 18F-FDG PET/CT and ultrasound in staging of patients with malignant melanoma
Authors: Weber Philipp , Arnold Andreas , Hohmann Joachim
Published: October 2022

Objective:

To evaluate the sensitivity and specificity of 2-18fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and ultrasound (US) for staging patients with malignant melanoma.

Methods:

In total, 258 patients (112 men and 146 women; mean age, 61 ± 16years) met the primary inclusion criteria for malignant melanoma without further malignancy proven by histopathology. This was a retrospective study of the diagnostic accuracy. All data were obtained from the hospital’s patient and radiology information system. Patients formed a consecutive series and were examined by 18F-FDG PET/CT and 176 additionally by US (US as a whole [wUS], peripheral lymph nodes [pUS], abdomen [aUS]), with a total of 584 18F-FDG PET/CT and 697 US. 18F-FDG PET/CT and US revealed 824 and 726 lesions, respectively. Per-patient, per-examination, and per-lesion analyses were also performed. The reference standards used were histopathology or resection of lesions, and follow-up controls using other imaging methods.

Results:

Significant differences (P < .05) were found in the per-examination for the sensitivity of 18F-FDG PET/CT (0.80) compared to wUS (0.63) and pUS (0.61), and the specificity of 18F-FDG PET/CT (0.96) compared to wUS (0.98) and aUS (0.99). In the PLA, there were significant differences in sensitivity and specificity for 18F-FDG PET/CT (0.83, 0.91) compared to wUS (0.61, 0.98), pUS (0.60, 0.98), and aUS (0.61, 0.99).

Conclusion:

18F-FDG PET/CT is preferable to US for detecting both lymph node and abdominal metastases.
Long-term effects of hematopoietic growth factors in aplastic anemia patients treated with immunosuppression: Meta-analysis of randomized controlled trials
Authors: Wang Anzi , Su Dongyun , Luo Jingyuan , Fu Yuhan , Li Qing , Chen Shu
Published: October 2022

Background and purpose:

Immunosuppressive therapy is the frontline treatment for aplastic anemia patients ineligible for transplantation. The long-term effects of hematopoietic growth factors (HGF) added to standard immunosuppressive therapy are still unclear. We performed a systematic review and meta-analysis to clarify this issue.

Methods:

A comprehensive search of databases was conducted including 5 international electronic databases (Cochrane, PubMed, Embase, Web of Science, and LILACS) and 4 Chinese electronic databases (Chinese Bio-medicine Database, Chinese National Knowledge Infrastructure, WanFang Data, and China Science and Technology Journal Database databases) from database inception until February, 2022. We included randomized controlled trials that assigned patients with acquired aplastic anemia treated with immunosuppressive therapy (IST), which compared between the addition of HGF and placebo or no treatment. The co-primary outcome were the overall survival (OS) and late clonal malignant evolution at the end of follow-up.

Results:

Nine randomized controlled trials including 719 participants were identified. The addition of growth factors to immunosuppression yielded no difference in OS (relative risks [RR], 1.08, 95% confidence interval [CI] 0.99–1.18). HGF was not associated with higher occurrence of secondary myelodysplastic syndromes/acute myeloid leukemia (RR, 1.09, 95% CI 0.43–2.78) or paroxysmal nocturnal hemoglobulinemia (RR, 1.38, 95% CI 0.68–2.81) at the end of follow-up. No difference were found in overall response (RR, 1.16, 95% CI 0.98–1.37), infections occurrence (RR, 0.82; 95% CI, 0.51–1.31) or relapse (RR, 0.65; 95% CI, 0.37–1.13).

Conclusions:

HGF as an adjunct to IST has no impact on long-term OS, late clonal malignant evolution, response rate, relapse or infections occurrence. HGF could be added to standard IST for high-risk patients with delayed neutrophil recovery without concern for long-term consequences but could not be recommended as routine clinical practice.

Trial registration number:

PROSPERO CRD42021275188.
Aging-related changes in knee flexor muscle strength and cross-sectional area
Authors: Park Soo Yeon , Yoon Kyoung Ho , Hwang Sung Hyun , Ko Taeg Su , Lee Hee Sung
Published: October 2022

Weakening muscle strength around the knee tends to render it vulnerable to aging-related damage. This study aimed to examine the association between knee flexor muscle strength and its cross-sectional area (CSA). We also evaluated aging-related changes in flexor muscle strength and CSA. We retrospectively analyzed 252 patients with acute-onset knee pain (<1 month) between September 2006 and August 2009 in accordance with the Strengthening the Reporting of Observational studies in Epidemiology statement. The CSA of each knee flexor muscle (biceps femoris, sartorius, gracilis, semitendinosus (ST), and semimembranosus (SM)) was measured on magnetic resonance imaging axial images at the suprapatellar level. We evaluated flexor muscle strength (peak torque in N.m) using a Cybex dynamometer at 60°/second and 180°/second and its correlation with CSA. In total, 252 patients (mean age, 34.5 years; range, 11 to 66 years; 184 men and 68 women) were included in this study. No significant intergroup differences in demographic data such as sex or body mass index were found. Mean CSA was 605.4 mm2 for the SM, 444.7 mm2 for the biceps femoris, 282 mm2 for the sartorius, 55.4 mm2 for the ST, and 34.1 mm2 for the gracilis. Mean peak torques were 67.4 N.m and 52.7 N.m at 60°/second and 180°/second, respectively. CSA was positively correlated with flexion strengths of 60°/second (R = 0.363, P < .001) and 180°/second (R = 0.354, P < .001). Muscle strength was associated with CSA in all muscles but the gracilis (R = 0.056, P = .375). Flexion strength decreased significantly with aging from the thirties. Total CSA decreased with aging (r = −0.247, P < .001). The CSA of the biceps femoris, sartorius, SM, and ST decreased significantly, whereas that of the gracilis tended to decrease non-significantly with aging. Flexor muscle strength was associated with total muscle CSA on magnetic resonance imaging and the CSA of every muscle except the gracilis. Flexion strength decreased significantly with aging after the twenties, while total CSA decreased significantly with aging. The CSA of all flexor muscles decreased significantly with aging, whereas that of the gracilis decreased only slightly.
Adapting the International Dysphagia Diet Standardisation Initiative in East Asia: Feasibility study
Authors: Son Woo Chul , Min Ji Yeon , Shin Hee Tae , Seo Kyung Cheon , Choi Kyoung Hyo
Published: October 2022

In dysphagia, food or water cannot be delivered safely through the oral cavity to the stomach; both are treated using texture-modified food and thickened fluid. Before, each country had its own diet modifications and texture measurement standards. In 2012, the International Dysphagia Diet Standardisation Initiative (IDDSI) was developed by several countries. Owing to cultural differences, it was necessary to determine whether the IDDSI could well be applied to clinicians and patients without difficulties in East Asia countries. To evaluate the IDDSI scale to find out the difficulties applying this scale in East Asia countries to educate the clinicians and patients. In May 2021, we enrolled physicians, nurses, nutritionists, and swallowing therapists involved in dysphagia treatment at a single center in Seoul. To evaluate the degree of understanding and difficulties of adapting IDDSI to clinicians in East Asia countries, we used the 17-item questionnaire with IDDSI sample foods and foods in Asian countries. In first 7 items, we compared IDDSI with the previously used scale based on the National Dysphagia Diet (NDD). In the next 10 questions, only the IDDSI levels were answered, and the absolute values of the answer–response differences were calculated. The IDDSI showed a significantly high intraclass correlation with the previously used NDD-based scale; the coefficient was higher for the nutritionists (0.988) and swallowing therapists (0.991). When evaluating whether the IDDSI could applied well in East Asia countries, the absolute values of the answer–response differences were lower than 0.5 in majority of levels, except for Level 4. Because the IDDSI framework might successfully be applied universally regardless of food culture, a worldwide standard for food rheology in dysphagia treatment might be possible.
A survey of clinical and laboratory characteristics of the dengue fever epidemic from 2017 to 2019 in Zhejiang, China
Authors: Ren Ze-Ze , Zheng Yi , Sun Tao , Wang Gang-Yi , Chen Xiao-Mei , Zhou Yu-Mei
Published: October 2022

To explore the epidemic, clinical, and laboratory characteristics of dengue patients in Zhejiang and the possible mechanism. Epidemic, clinical and laboratory data of 231 dengue patients admitted to the Second Affiliated Hospital of Zhejiang Traditional Chinese Medicine University between August 2017 and December 2019 were collected. GSE43777 dataset was downloaded from the Gene Expression Omnibus database and was used for the immune cell infiltration analysis, logistic regression analysis, and nomogram construction. Gene set enrichment analysis (GSEA) was performed to explore the possible regulatory pathways in dengue infection. Further, the receiver operating characteristic curve analysis and decision curve analysis were conducted to evaluate the value of related immune cells in predicting dengue severity. Among the 231 patients, the gender ratio was 1:1.1 (male/female). The patients in the <60 years age group, 60 to 80 years age group, and >80 years age group were 47.2%, 45.5%, and 7.3%, respectively. The major symptoms were fever (100%), weak (98.3%), anorexia (76.6%), muscle and joint pain (62.3%), and nausea (46.8%). In dengue patients, 98.7% of serum samples had decreased platelet levels, 96.5% of them had decreased white blood cell (WBC) levels, 97.8% had elevated aspartate aminotransferase levels, 82.3% had elevated lactate dehydrogenase levels, 49.4% had increased creatinine levels, and 35.5% had increased creatine kinase levels. Pneumonia, pleural effusion, and bilateral pleural reaction were observed in 16.5%, 8.2%, and 4.8%, respectively of dengue patients. Gallbladder wall roughness and splenomegaly accounted for 6.1% and 4.3% of all cases. Moreover, the levels of T cell, B cell, and dendritic cells were significantly higher in the convalescent group and they were involved in immune- and metabolism-related pathways. Of note, low levels of these 3 immune cells correlated with high dengue infection risk, while only dendritic cells exhibited satisfactory performance in predicting dengue severity. Dengue fever patients often onset with fever, accompanied by mild abnormalities of the blood system and other organ functions. Moreover, T cells, B cells, and dendritic cells might be involved in dengue infection and development.
A randomized controlled trial comparing incidences of postoperative nausea and vomiting after laparoscopic cholecystectomy for preoperative intravenous fluid loading, ondansetron, and control groups in a regional hospital setting in a developing country
Authors: Wongyingsinn Mingkwan , Peanpanich Pechprapa , Charoensawan Sirirat
Published: October 2022

Background:

Postoperative nausea and vomiting (PONV) is a common complication in inpatient and outpatient settings. Multimodal approaches have been pursued to minimize this undesirable outcome. Despite consensus guidelines for the management of PONV have been updated and published for many years, data from our pilot study showed that patients with high-risk surgeries for PONV, laparoscopic cholecystectomy (LC), still hardly received perioperative PONV prophylaxis. This study aimed to compare the incidences of PONV in adult patients undergoing elective LC who were administered preoperative intravenous fluid loading, ondansetron, or neither fluid nor ondansetron in the setting of a regional hospital in a developing country.

Methods:

The study was designed as a prospective randomized controlled trial. The total of 171 patients was allocated to three groups: one received fluid loading with Ringer’s lactate solution before the operation; the second received ondansetron; and the third group received neither.

Results:

In total, 156 patients were analyzed. Their demographic data, history of motion sickness/PONV, and smoking status were not significantly different. The overall incidences of PONV within 24 hours of surgery were 29.1% in the fluid group, 18.4% in the ondansetron group, and 25% in the control group, but the difference was not statistically significant (P = .442). In subgroup analysis, the incidences of PONV and PON in patients younger than 50 years old were significantly different among the three groups (P = .008). A post hoc analysis showed that patients under 50 years in the ondansetron group had significantly lower incidences of PONV and PON than those in the control and fluid groups. However, the incidences of morphine consumption and dizziness in the ondansetron group were significantly higher than those of the two other groups.

Conclusions:

Neither the preoperative intravenous fluid loading nor the ondansetron affected PONV in patients aged 50 and older undergoing LC, compared with control. Ondansetron was beneficial for PON prophylaxis in patients under the age of 50, whereas preoperative intravenous fluid loading was considered a risk factor for PON in this population.
Efficacy and safety of dual antiplatelet therapy after percutaneous coronary drug-eluting stenting: A network meta-analysis
Authors: Luo Lin , Wang Shenglin , Tang Kai , Yang Xu , Wu Jianli , Wang Dan , Xu Liqiong , Feng Tao , Li Dejin , Ran Jiuju , Li Debo , Zhang Li , Zhao Dan
Published: October 2022

Background:

To evaluate the efficacy and safety of dual antiplatelet regimens after coronary drug-eluting stenting by network meta-analysis (NMA).

Methods:

PubMed, The Cochrane Library, Embase, and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different dual antiplatelet regimens after coronary drug-eluting stenting from inception to September 1st, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Stata 16.0 software was used for NMA.

Results:

A total of 27 RCTs involving 79,880 patients were included. The results of NMA: in terms of myocardial infarction (MI), other 3 interventions were higher than the long-term dual antiplatelet therapy (L-DAPT) (the standard dual antiplatelet therapy [Std-DAPT] [odds ratio [OR] = 1.82, 95%confidence interval [CI]: 1.49-2.21), the aspirin monotherapy after short-term dual antiplatelet therapy (S-DAPT + As) (OR = 2.06, 95%CI: 1.57-2.70), the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (S-DAPT + P2Y12) (OR = 1.71, 95%CI: 1.29-2.28)]. In terms of stent thrombosis, other 3 interventions were higher than L-DAPT [Std-DAPT (OR = 2.18, 95%CI: 1.45-3.28), S-DAPT + As (OR = 2.32, 95%CI: 1.52-3.54), S-DAPT + P2Y12 (OR = 2.31, 95%CI: 1.22-4.36)]. There was no statistically significant difference among the 4 interventions in prevention of stroke and all-cause mortality (P > .05). In terms of cardiovascular and cerebrovascular adverse events, other 3 interventions were higher than L-DAPT (Std-DAPT [OR = 1.28, 95%CI: 1.12-1.45], S-DAPT + As [OR = 1.27, 95%CI: 1.09-1.48], S-DAPT + P2Y12 [OR = 1.24, 95%CI: 1.01-1.52]). In terms of safety, bleeding rate of other 3 interventions were lower than L-DAPT (Std-DAPT [OR = 0.67, 95%CI: 0.52-0.85], S-DAPT + As [OR = 0.51, 95%CI: 0.39-0.66], S-DAPT + P2Y12 [OR = 0.36, 95%CI: 0.26-0.49]). Two interventions were lower than L-DAPT (S-DAPT + As [OR = 0.77, 95%CI: 0.65-0.90], S-DAPT + P2Y12 [OR = 0.54, 95%CI: 0.44-0.66]). S-DAPT + As was higher than L-DAPT (OR = 1.42, 95%CI: 1.10-1.83).

Conclusions:

S-DAPT + P2Y12 has the lowest bleeding risk, while L-DAPT has the highest bleeding risk. In the outcome of MI, stent thrombosis, and cardiovascular and cerebrovascular adverse events, L-DAPT has the best efficacy. In the outcome of stroke and all-cause mortality, the 4 interventions were equally effective.
Risk factors associated with increased incidences of catheter-related bloodstream infection
Authors: Moriyama Kiyoshi , Ando Tadao , Kotani Mariko , Tokumine Joho , Nakazawa Harumasa , Motoyasu Akira , Yorozu Tomoko
Published: October 2022

We have implemented several preventive measures to reduce central line-associated bloodstream infection (CLABSI) in the general intensive care unit (ICU) of a university hospital in Japan. Here, we analyzed the factors associated with CLABSI in patients with central venous catheter (CVC) insertions and evaluated the effects of our implemented preventive measures. From July 2013 to June 2018, data was collected from the medical records of 1472 patients with 1635 CVC insertions, including age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, duration of catheter insertion, insertion site, and mechanical ventilation status. During weekly conferences, a surveillance team comprising intensive care and infection control doctors and nurses determined the patients’ CLABSI status. The analyzed factors were compared between CLABSI and central line patients without bloodstream infection. Multivariate analysis revealed three factors associated with CLABSI. Adjusted odds ratios with 95% confidence intervals were as follows: duration of ICU stay, 1.032 (1.019–1.044); duration of catheter insertion, 1.041 (1.015–1.066); and APACHE II score, 1.051 (1.000–1.105). The prominent risk factors were associated with the severity of the initial condition and exacerbation of the clinical condition of the patients during their stays in the ICU. Further strategies to reduce CLABSI must be developed.
Real-world comparative effectiveness of bDMARDs and JAK inhibitors in elderly patients with rheumatoid arthritis
Authors: Temmoku Jumpei , Migita Kiyoshi , Yoshida Shuhei , Matsumoto Haruki , Fujita Yuya , Matsuoka Naoki , Yashiro-Furuya Makiko , Asano Tomoyuki , Sato Shuzo , Suzuki Eiji , Watanabe Hiroshi , Miyata Masayuki
Published: October 2022

In this retrospective cohort study, we compared the retention rates and effectiveness of biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (targeted disease modifying antirheumatic drug [tsDMARDs]: Janus kinase inhibitors [JAKi]) in elderly patients with RA. One hundred thirty-four elderly RA patients (≥65 years) who were initiated with bDMARDs (n = 80) or JAKi (n = 54) between 2016 and 2020 in our institute were enrolled in this analysis. Follow-up was conducted at 4-week intervals from the start of bDMARDs or JAKi. We compared the drug retention and clinical response at 24 week between elderly RA patients treated with bDMARDs and JAKi. In the demographic data, more disease duration, the proportion of previous bDMARDs use and less the proportion of glucocorticoid use in JAKi group was significantly observed compared to the bDMARDs group. Otherwise, there was no significant difference in the other variables between the bDMARDs and JAKi groups. In the JAKi group, drug retention rate was not significantly different compared to the bDMARDs group (HR: 0.723, 95% CI: 0.406–1.289, P = .266). Also, there was no significant difference in the proportion of patients achieving good or moderate European alliance of associations for rheumatology (EULAR) response at 24 week between these two groups (bDMARDs; 88.6% vs JAKi; 91.8%, P = .158). In elderly RA patients initiated with bDMARDs or JAKi, drug retention rates of these targeted therapies did not differ significantly between these two groups. These findings suggest that elderly RA patients can achieve similar clinical improvement after initiating bDMARDs or JAKi.
Fecal calprotectin in predicting small bowel capsule endoscopy findings in pediatric patients with known Crohn’s disease
Authors: Wang Shengnan , Miao Shijian , Qiu Xiaoxia , Wu Jie , Wang Yuhuan
Published: October 2022

Fecal calprotectin (FC) has been proposed as a noninvasive surrogate marker of intestinal inflammation in inflammatory bowel disease. This study aimed to assess the capability of FC in predicting small bowel capsule endoscopy (SBCE) findings in pediatric patients with known Crohn’s disease (CD). We retrieved data of consecutive patients aged 2 to 17 years old with established CD who underwent SBCE from Janurary 2017 to April 2020 and had endoscopic remission on ileocolonoscopy. Sixty-eight patients were included in the analysis. There were 13 patients with a weighted pediatric CD activity index ≥ 12.5, 47 patients with FC ≥ 200 µg/g, and 45 patients with significant small bowel (SB) inflammation [Lewis score (LS) ≥ 135]. The LS correlated weakly with FC (R = 0.30, P < .05). The area under the curve of FC as a surrogate diagnostic test for LS ≥ 135 was 0.691, and the optimal FC cutoff values were 242 µg/g with the corresponding sensitivity and specificity of 78% and 65%, respectively. The area under the curve of FC for moderate-to-severe inflammatory activity in the SB was 0.718. In patients with FC level ≥ 670 µg/g, LS ≥ 790 was found in 33% (9/27) of patients, with the sensitivity and specificity of 69% and 67%, respectively. FC may be used to predict SB mucosal inflammation in pediatric patients with confirmed CD having endoscopic remission on ileocolonoscopy.