bluuebunny/crossref_metadata_2025 huggingface dataset:
The efficacy of statins in the treatment of rheumatoid arthritis: A systematic review and meta-analysis
Authors: Ren Conglin , Li Mingshuang
Published: September 2023

Background:

A large body of research has investigated the use of statins in rheumatoid arthritis (RA); however, the therapeutic effects of statins remain uncertain. Thus, we designed a systematic review and meta-analysis to evaluate the role of statins in patients with RA.

Methods:

Databases searched to detect clinical randomized controlled trials or clinical controlled trials on the interaction between statins and RA before January 2020 included PubMed, Web of Sciences, Embase, Cochrane Library, CNKI, Wan Fang Database. Efficacy was measured by Disease Activity Score in 28 Joints (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tenderness of the joint (TJ), swelling of the joint (SJ), and interleukin-6. The level of blood lipid was also evaluated. STATA 12.0 was used for the meta-analysis. The Cochrane method was used for quality assessment. Heterogeneity was considered to determine fixed effects or random effects models.

Results:

Nineteen clinical trials with a total of 22,906 subjects were included in the meta-analysis. Sixteen studies reported a change in DAS28 after statin treatment. The pooled analysis showed that statins reduced DAS28 in RA patients. Change in ESR after statin treatment was reported in 9 studies. The summary analysis showed that statins lowered ESR in RA patients. Twelve studies reported a change in CRP after statin treatment. The results of the entire analysis showed that statins lowered CRP in RA patients. Seven studies reported a change in TJ after statin treatment. The combined analysis showed that statins reduced TJ at RA patients. Six studies reported changes in IL6 after statin therapy. The results showed that statins failed to reduce IL6 in RA patients. Seven studies reported changes in SJ after statin therapy, which showed that statins failed to reduce SJ in RA patients. We also found that statins can reduce blood lipid levels in RA patients.

Conclusion:

In conclusion, statins were able to reduce DAS28, ESR, CRP, TJ, and blood lipids. It indicated that stains can benefit patients with RA by inhibiting the expression of inflammatory factors and reducing the levels of lipids in the blood. Our study may offer a new perspective on the treatment of RA and provide research ideas for future larger multi-center clinical trials.
CircMACF1 alleviates myocardial fibrosis after acute myocardial infarction by suppressing cardiac fibroblast activation via the miR-16-5p/SMAD7 axis
Authors: Wang Yonghong , Liu Yanfei , Fei Aike , Tan Liming
Published: September 2023

Circular RNAs (circRNAs) played a pivotal role in myocardial fibrosis after acute myocardial infarction (AMI). The activation of cardiac fibroblasts (CFs) and accumulation of extracellular matrix are the main characteristics of myocardial fibrosis. In our research, we aimed to elucidate the functional roles of circMACF1 in CF activation after AMI as well as the underlying mechanism. Human CFs were activated by TGF-β1 treatment. qPCR and western blotting were performed to investigate gene and protein expression. CCK-8 and transwell assays were carried out to measure cell proliferation, and migration. Immunofluorescence was used to investigate α-SMA level. The interaction between miR-16-5p and circMACF1 or SMAD7 was revealed by RIP or dual luciferase reporter gene assays. CircMACF1 and SMAD7 were repressed in AMI patients and CFs treated with TGF-β1, and miR-16-5p was increased. In addition, circMACF1 was resistant to RNase R and abundantly expressed in the cytoplasm. Overexpression of circMACF1 inhibited cell proliferation and migration and reduced the expression levels of fibrosis-related proteins, including Collagen I, Collagen III, and α-SMA. Furthermore, circMCAF1 could directly bind to miR-16-5p, and SMAD7 was a target gene of miR-16-5p. Knockdown of miR-16-5p suppressed the activation, proliferation, and migration of TGF-β1-treated CFs, but silencing circMACF1 or SMAD7 partially reversed this phenomenon. CircMACF1 attenuated the TGF-β1-induced activation, proliferation and migration of CFs via the miR-16-5p/SMAD7 signaling pathway, indicating that circMACF1 might be a new therapeutic target for AMI.
Identification of prognostic immune subtypes of lung squamous cell carcinoma by unsupervised consistent clustering
Authors: Wang, Yuhan , Hou, Litie , Yang, Miao , Fan, Jinyan , Wang Yanbo , Sun Liping
Published: September 2023

We performed UCC on the expression data of lung squamous cell carcinoma tumor samples to identify the classification of lung squamous cell carcinoma (LUSC) tumor samples, and calculated the levels of different classified immune cells by single-sample gene enrichment analysis (ssGSEA) to obtain a set of immune-related subtype gene tags, which can be used for subtype classification of lung squamous cell carcinoma. TCGA-LUSC and GSE30219 data of lung squamous cell carcinoma were obtained from TCGA and GEO databases. Prognostic-associated subtypes were identified by unsupervised consensus clustering (UCC). Using ssGSEA analysis to calculate the level of immune cells of different subtypes, obtain the connection between subtypes and immunity, identify the gene signatures recognized by subtypes, and verify this group of gene signatures through GSE30219. We effectively identified 2 subtypes that were significantly associated with prognostic survival by UCC, and calculated according to ssGSEA, the 2 subtypes were significantly different at the level of immune cells, followed by introducing a This weighted thinking computes a set of gene signatures that are significantly associated with subtype 1. During validation, this set of gene signatures could efficiently and robustly identify distinct prognostic immune subtypes, demonstrated the validity of this set of gene signatures, as well as 2 subtypes of lung squamous cell carcinoma. We used lung squamous cell carcinoma data from public databases and identified 2 prognostic immunosubtypes of lung squamous cell carcinoma and a set of gene tags that can be used to classify immune subtypes of lung squamous cell carcinoma, which may provide effective evidence for accurate clinical treatment of lung squamous cell carcinoma.
How to predict the outcome of primary brainstem hemorrhage: Six-year results of a single-center retrospective analysis
Authors: Geng Yibo , Wang Tao , Liu Yiqi , Liu Xiaoli , Wang Yang , Tan Ke , Li Xiong , Li Jinping
Published: September 2023

Primary brainstem hemorrhage (PBH) is one of the most fatal intracranial hemorrhages, evaluating the prognosis in the early stage is vital for appropriate therapeutic planning. Our study aimed to identify risk factors for 30-day mortality and 90-day functional recovery of PBH. Data from 63 patients with PBH admitted to Beijing Chaoyang Hospital between 2016 and 2022 were retrieved for this study. We grouped the patients according to 30-day survival or 90-day functional recovery. Independent risk factors of 30-day mortality and 90-day functional recovery were identified by univariate and multivariate logistic regression analyses. 31 patients (49.2%) died within 30 days and 22 patients (34.9%) achieved better functional recovery. By multivariate analysis, Glasgow coma scale <9 on admission and tachycardia were significantly associated with 30-day mortality, while the hematoma volume >5 mL was an independent risk factor for 90-day functional recovery. Initial level of consciousness, tachycardia, massive hematoma were risk factors for prognosis, which must be seriously evaluated for therapeutic planning.
Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial
Authors: Mermer Aydin , Simsek Gurcan , Mermer Hasan Alp , Tire Yasin , Kozanhan Betül
Published: September 2023

Background:

Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy.

Methods:

Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality.

Results:

The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001).

Conclusion:

The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.
Gestational glucose intolerance and pregnancy outcomes: a retrospective study in the primary care setting of Macau
Authors: Lei Sao Kuan , Wong Chi Leong , Leung Ka Pou , Shum Tai Chun
Published: September 2023

Although glucose intolerance is prevalent in Macau, it is rarely assessed during pregnancy. This study examined short-term maternal and neonatal outcomes at different maternal glucose levels in Macau. A total of 2388 pregnant women who received antenatal care at Health Centers and delivered at the Centro Hospitalar Conde de São Januário between June 2018 and December 2019 were included in this study. Gestational diabetes mellitus (GDM) was diagnosed using Carpenter and Coustan criteria, involving a 50 g glucose challenge test (GCT) followed by a 100g oral glucose tolerance test (OGTT). Participants were categorized into 4 groups: normal glucose tolerance if GCT was negative; mild gestational hyperglycemia in this study if positive GCT without GDM; GDM patients with normal fasting blood glucose (FBG) or high FBG in OGTT. Logistic regression analysis was employed to compare pregnancy outcomes among these 4 groups. Due to the limited number of cases, we combined several adverse maternal outcomes, including pregnancy-induced hypertension, assisted delivery, primary Caesarean section, moderate to severe perineal trauma, and postpartum hemorrhage, into a composite measure. The results showed higher rates of the aforementioned outcomes for mild gestational hyperglycemia and GDM with high FBG in OGTT groups [adjusted odds ratio (aOR) 1.32, 95% confidence interval (CI) 1.06–1.64; aOR 2.04, 95% CI 1.24–3.37], as well as macrosomia risk (aOR 2.02, 95% CI 1.11–3.66; aOR 5.04, 95% CI 2.03–12.52) and large-for-gestational age infants (aOR 1.48, 95% CI 1.02–2.16; aOR 4.34, 95% CI 2.31–8.15). Pregnancy outcomes were similar for normal glucose tolerance and GDM with normal FBG in OGTT. Mild gestational hyperglycemia raised the likelihood of adverse maternal outcomes and excessive infant birth weights. Even after achieving target glucose levels, GDM patients with elevated fasting glucose readings in OGTT remained at significant risk for these events. Instead, fasting normoglycemic GDM was treated effectively at Macau Health Centers.
The relationship between neutrophil lymphocyte ratio, platelet lymphocyte ratio, and depression in dialysis patients
Authors: Tutan Duygu , Erdoğan Kaya Ayşe , Eser Bariş
Published: September 2023

Chronic kidney disease is a worldwide public health issue with rising incidence, morbidity/mortality, and cost. Depression and chronic renal disease often coexist, and psychological illnesses are associated with poor results. Early identification of depression reduces morbidity and death. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are reported as practical biomarkers of inflammation and immune system activation. In this study, we aimed to determine the association of NLR and PLR with depression in dialysis patients. This study included 71 adults over 18 without known hematologic or oncologic disease, drug use, or chronic inflammatory diseases. Comorbid chronic diseases, laboratory data, and Beck depression inventory scores were prospectively recorded. A comparison of 2 groups according to the existence of depression was made, and a binomial logistic regression test was used to determine the association between the variables and the presence of depression after adjusting for confounding factors. A receiver operating curve analysis was used to differentiate groups with and without severe depression. Seventy-one patients met the study criteria, with 46 hemodialysis and 25 peritoneal dialysis patients. The majority had hypertension and diabetes mellitus, with 47.89% having minimal-minor depression and 52.11% having moderate-major depression. The 2 groups were similar regarding chronic diseases, with no significant differences in serum creatinine levels, glucose, lipid profiles, or electrolytes. However, when the NLR of the 2 groups was compared, the median was higher in patients with moderate or major depression. Multivariate analysis showed no significant differences between the groups in PLR, triglyceride to glucose ratio, and C-reactive peptide to albumin ratio. The best NLR cutoff value was 3.26, with 48.6% sensitivity, 88.2% specificity, 81.8% positive predictive value, 61.2% negative predictive value, and 67.6% test accuracy. Depression is one of the most common psychiatric conditions in dialysis patients and is linked to increased morbidity, mortality, treatment failure, expense, and hospitalization. NLR helped predict moderate-to-major depression in dialysis patients, even after controlling for confounding factors in multivariate analysis. This study indicated that an NLR successfully identified depressive groups, and patients with an NLR value >3.26 were 6.1 times more likely to have moderate or major depression.
HBOT has a better cognitive outcome than NBH for patients with mild traumatic brain injury: A randomized controlled clinical trial
Authors: Liu Zhiguo , Wang Xirui , Wu Zhiyou , Yin Gangfeng , Chu Haibin , Zhao Pengyue
Published: September 2023

Background:

Normobaric hyperoxia (NBH) and hyperbaric oxygen therapy (HBOT) are effective treatment plan for traumatic brain injury (TBI). The aim of this study was to compare cognitive outcome after mild TBI between NBH and HBOT so as to provide a more suitable treatment strategy for patients with mild TBI.

Methods:

A prospective research was conducted between October 2017 and March 2023, enrolling patients with mild TBI (Glasgow coma scale score: 13–15 points) within 24 hours of injury in Cangzhou Central Hospital. Patients were randomized into 3 groups: group control (C), group NBH and group HBOT. The patients in HBOT group received hyperbaric oxygen therapy in high pressure oxygen chamber and patients in NBH group received hyperbaric oxygen therapy. at 0 minute before NBH or HBOT (T1), 0 minute after NBH or HBOT (T2) and 30 days after NBH or HBOT (T3), level of S100β, NSE, GFAP, HIF-1α, and MDA were determined by ELISA. At the same time, the detection was performed for MoCA and MMSE scores, along with rSO2.

Results:

The results showed both NBH and HBOT could improve the score of MoCA and MMSE, as well as the decrease the level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2 compared with group C. Furthermore, the patients in group HBOT have higher score of MoCA and MMSE and lower level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2.

Conclusion:

Both NBH and HBOT can effectively improve cognitive outcome for patients with mild TBI by improving cerebral hypoxia and alleviating brain injury, while HBOT exert better effect than NBH.
Clinicopathological correlations of endometrioid and clear cell carcinomas in the uterus and ovary
Authors: Mori Hidemi , Nishida Haruto , Kusaba Takahiro , Kawamura Kazuhiro , Oyama Yuzo , Daa Tsutomu
Published: September 2023

Endometrioid carcinoma (EC) and clear cell carcinoma (CC) are associated with endometrial tissue hyperplasia and endometriosis, and they occur in the endometrium and ovaries. However, detailed differences between these tumors based on immunostaining are unclear; therefore, in this study, we aimed to analyze the clinicopathological correlations between these tumors using immunostaining and to develop new treatments based on histological subtypes. Immunohistochemistry was used to investigate differentially expressed hypoxia-associated molecules (hypoxia-inducible factor-1 subunit alpha [HIF-1α], forkhead box O1, prostate-specific membrane antigen, signal transducer and activator of transcription 3 [STAT3], hepatocyte nuclear factor 1β [HNF-1β], aquaporin-3, and vimentin [VIM]) between these carcinomas because of the reported association between CC and ischemia. Immunostaining and clinicopathological data from 70 patients (21 uterine endometrioid carcinomas [UECs], 9 uterine cell carcinomas, 20 ovarian endometrioid carcinomas [OECs], and 20 ovarian cell carcinomas [OCCs]) were compared. HIF-1α and prostate-specific membrane antigen expression levels were higher in UEC and OCC than in uterine cell carcinomas and OEC. STAT3 was slightly overexpressed in UEC. Additionally, forkhead box O1 expression was either absent or significantly attenuated in all ECs. VIM and AQ3 were highly expressed in UEC, whereas HNF-1β expression was higher in OCC. UEC, OEC, and OCC were more common in the uterine fundus, left ovary, and right ovary, respectively. Ovarian endometriosis was strongly associated with EC. Our findings suggest that UEC and OCC share a carcinogenic pathway that involves HIF-1α induction under hypoxic conditions via STAT3 expression, resulting in angiogenesis. Furthermore, the anatomical position of carcinomas may contribute to their carcinogenesis. Finally, aquaporin-3 and VIM demonstrate strong potential as biomarkers for UEC, whereas HNF-1β expression is a crucial factor in CC development. These differences in tumor site and histological subtypes shown in this study will lead to the establishment of treatment based on histological and immunohistological classification.
Epidemiology of liver transplantation and post-LT complications in Germany: nationwide study (2005–2018)
Authors: Gu Wenyi , Schaaf Louisa , Hortlik Hannah , Zeleke Yasmin , Brol Maximilian J. , Schnitzbauer Andreas A. , Bechstein Wolf O. , Zeuzem Stefan , Queck Alexander , Peiffer Kai-Henrik , Tischendorf Michael , Pascher Andreas , Laleman Wim , Praktiknjo Michael , Schulz Martin S. , Uschner Frank E. , Rennebaum Florian , Trebicka Jonel
Published: September 2023

Background

To date, liver transplantation (LT) is the only curative treatment for cirrhosis and early-diagnosed progressive acute liver failure (ALF). However, LT results in morbidities and mortality even post-LT. Different comorbidities may follow and further increase mortality and morbidity. In this study, we investigated the outcomes and their trends over a period of 14 years among hospitalized patients evaluated for LT, transplant and post-LT in Germany.

Methods

This German nationwide study investigated the number of admissions of patients hospitalized for evaluation of LT and post-LT on related comorbidities and complications between 2005 and 2018 based on the DRG system with ICD-10/OPS codes. 14 745 patients were put on the LT waiting list and 12 836 underwent LT during the observational period.

Results

The LT number decreased by 2.3% over time, while the waiting list mortality rate increased by 5%. By contrast, the in-hospital mortality rate decreased by 3%, especially in ALF patients (decrease of 16%). Interestingly, admissions of post-LT patients for complications almost doubled, driven mainly by complications of immunosuppression (tripled). Importantly, post-LT patients with acute kidney injury (20.2%) and biliodigestive anastomosis (18.4%) showed the highest in-hospital mortality rate of all complications.

Conclusion

In conclusion, the decrease in LT leads most probably to the increased in-hospital mortality of patients on the waiting list. Interestingly, in-hospital mortality decreased in LT patients. Post-LT comorbidities requiring hospitalization increased in the observational period and management of patients post-LT with AKI or biliodigestive anastomosis should be addressed.
Potential missed diagnoses of Crohn’s disease in tertiary care: impact on drug utilization and healthcare facilities use
Authors: Ferraro Sara , Cappello Emiliano , Bartolini Claudia , Convertino Irma , Bertani Lorenzo , Lucenteforte Ersilia , Costa Francesco , Paoletti Olga , Giometto Sabrina , Gini Rosa , Tuccori Marco
Published: September 2023

Background

A missed diagnosis of Crohn’s disease (CD) can delay treatment initiation with consequences on disease course.

Aims

To measure the possible impact of missed diagnoses on drug utilization and access to healthcare facilities in a real-world cohort of CD patients.

Methods

This retrospective observational study has been conducted on the regional administrative databases of Tuscany (Italy). We included patients with a first record of CD diagnosis between 06/11/2011 and 06/30/2016. Possible missed diagnosis (exposure) was defined by hospital presentation for gastrointestinal symptoms consistent with CD diagnosis that occurred in the 7–60 months preceding CD diagnosis. We compared exposed and non-exposed patients by assessing time-free from biologic drugs and from Emergency Department (ED) or hospital access. Hazard ratio (HR) was calculated using Cox models.

Results

Among 3342 CD patients, 584 (17.5%) had a possible missed diagnosis. A risk of being treated with biologic drugs [adjusted HR (aHR): 2.17, 95% CI: 1.75–2.71] and of access to ED or hospitalization (aHR: 1.59, 95% CI: 1.44–1.75) was observed in patients with a possible missed diagnosis as compared to those without.

Conclusion

Tertiary care caregivers should be trained in the identification of early CD symptoms, to timely identify CD diagnosis and optimize pharmacological treatment and disease management.
Climate change and kidney stones
Authors: Maline Grace E. , Goldfarb David S.
Published: September 2023

Purpose of review

Kidney stones affect an increasing proportion of the population. We suggest that these trends are in part influenced by exposure to higher temperatures as a result of climate change and urbanization. The changing epidemiology of kidney stones is a topic worthy of discussion due to the economic and healthcare burden the condition poses as well as the quality-of-life disruption faced by individuals with kidney stones.

Recent findings

The relationship between heat and kidney stones is well supported. Exposure to high temperatures has been shown to increase risk for stone development within a short time frame. Effects are modified by factors such as sex, comorbid conditions, and population vulnerability and adaptability. Urban heat islands (UHIs) likely exaggerate the effect of increasing global surface temperature. The concentration of UHIs often coincides with historic redlining practices in the United States, potentially contributing to observed disparities in kidney health among minoritized populations. As global surface temperature increases and urbanization trends continue, a greater proportion of the world's population is exposed to significant temperature extremes each year, leading to the expectation that kidney stone prevalence will continue to increase.

This work describes the effect of increasing global surface temperature as a result of climate change on kidney stone disease and kidney health. These effects may result in further perpetuation of significant kidney stone related social disparities. We suggest strategies to mitigate the effects of heat exposure on stone formation.
Upsurge of Powassan virus disease in northeastern United States: a public health concern—a short communication
Authors: Anis Heeba , Basha Shaik Akbar , Karabulut Ece , Uzun Mert , Tiwari Angad , Nazir Abubakar , Uwishema Olivier , Alemayehu Abel
Published: September 2023

Powassan virus (POWV) is a tick-borne Flavivirus primarily transmitted through ticks in North America which is a significant public health threat in the northeastern United States. POWV infection spans from Ontario to the Mid-Atlantic, Northeast, and Midwest regions in the USA. Climate change, ecological factors, and human-related changes, including shifts in migration and agriculture, contribute to the dissemination of POWV. Symptoms include sore throat, fatigue, headache, and severe neuroinvasive conditions. Specialized attention is required for diagnosing and managing. MRI scans detect central nervous system abnormalities, while neuromonitoring identifies metabolic distress. Severe cases may necessitate ICU hospitalisation with continuous monitoring. Prevention measures, such as awareness, controlling mammals, and protecting pets, reduce POWV infection risk. The recent outbreak of POWV in Maine, USA, highlights the importance of worldwide collaboration for prevention. With the global prevalence of POWV increasing due to climate and socioeconomic changes, implementing preventative measures and promoting awareness are crucial in reducing infection risk.
Cervical Cerclage: A Comprehensive Review of Major Guidelines
Authors: Giouleka Sonia , Boureka Eirini , Tsakiridis Ioannis , Siargkas Antonios , Mamopoulos Apostolos , Kalogiannidis Ioannis , Athanasiadis Apostolos , Dagklis Themistoklis
Published: September 2023

Importance

Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates.

Objective

The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC.

Evidence Acquisition

A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out.

Results

There is a consensus among the reviewed guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2 guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate.

Conclusions

Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be able to identify the indications and contraindications of cervical cerclage; evaluate the prerequisites before cervical cerclage placement; and explain the strategies for perioperative and postoperative care after cervical cerclage placement.
Pediatric Rattlesnake Envenomations Treated With Crotalidae Equine Immune F(Ab’)₂ Antivenom
Authors: Seltzer Justin A. , Winkler Garret A. , Friedman Nathan A. , Galust Henrik , Hardin Jeremy , Srihari Priya , Ontiveros Sam , Corbett Bryan , Clark Richard F.
Published: September 2023

Objectives

Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab’)₂ antivenom (F(ab’)₂AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab’)₂AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab’)₂AV in children.

Methods

A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab’)₂AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.

Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab’)₂AV vials used, infusion-related complications, and clinical outcomes were collected.

Results

Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab’)₂AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4–34 vials; interquartile range, 8.75–12 vials). The median total vials given for all patients was 10 (10–44 vials; interquartile range, 10–20 vials).

Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.

After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal.

Conclusions

Although limited by small sample size and postdischarge follow-up, F(ab’)₂AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.
Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients
Authors: Karakas Hatice Dilara , Kuloglu Zarife , Aydin Fatma , Ozdemir Serpil , Avar-Aydin Pinar Ozge , Tuna Kirsaclioglu Ceyda , Cakar Nilgun , Ozcakar Zeynep Birsin
Published: September 2023

Objective

Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients.

Methods

The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records.

Results

A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases.

Conclusion

Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.
HIV-Associated Rheumatic Diseases
Authors: Akram Bushra , Khan Meeshal , Humphrey Mary Beth
Published: September 2023

Human immunodeficiency virus (HIV) is widely prevalent among the world population. Although, historically, it has been linked to opportunistic infections in keeping with immunodeficiency and immune dysregulation, it has also been associated with a wide variety of autoimmune manifestations. With the introduction of highly active antiretroviral therapy and subsequent restoration of immunity, there have been multiple immune-mediated diseases that have resurfaced in the HIV population. Our review highlights autoimmune diseases in association with HIV and its targeted therapies in detail.
A 3 mm Port Reduces Postoperative Pain After Laparoscopic Colon Cancer Surgery: A Case-control Matched Study
Authors: Choi Jin Sun , Kim Hyo Jun , Lim Han-Ki , Kim Min Jung , Shin Rumi , Park Ji Won , Ryoo Seung-Bum , Park Kyu Joo , Park Hyeree , Shin Aesun , Jeong Seung-Yong
Published: September 2023

Background:

Recently, smaller-size trocars and instruments have been developed for laparoscopic colon cancer surgery; however, their effectiveness and safety have not been elucidated. This study aimed to investigate whether 3 mm trocars and instruments have benefits compared with conventional trocars and instruments.

Patients and Methods:

Patients with colon cancer who underwent laparoscopic anterior resection or right hemicolectomy were included. Patients who underwent combined resections of other organs and those with conversion to open surgery were excluded. In the 3 mm group, three 5 mm trocars were replaced by 3 mm trocars. The numeric rating scale (NRS) immediately postoperatively at 24, 48, and 72 hours, respectively, after surgery and the use of additional analgesics and perioperative outcomes were analyzed. Case-control matched analysis was used to reduce bias according to the type of surgery.

Results:

A total of 207 patients (conventional: n = 158, 3 mm: n = 49) were included. Before matching, NRS 48 hours postoperatively (P = 0.049), proportion of patients using additional intravenous (IV) analgesics (P = 0.007), postoperative hospital stay (P < 0.001), and blood loss (P < 0.001) were lower in the 3 mm group. In multivariable analysis, trocar type significantly impacted the proportion of patients using additional IV analgesics (odds ratio: 0.330; 95% CI: 0.153-0.712; P = 0.005). After case-control matching, NRS immediately postoperatively (P = 0.015) and 24 hours postsurgery (P = 0.043), patients using additional IV analgesics (P = 0.019), postoperative hospital stay (P = 0.010), intraoperative blood loss (P < 0.001), and postoperative complication rate (P = 0.028) were significantly lower in the 3 mm group compared with the 5 mm group.

Conclusions:

The use of 3 mm trocars and instruments in laparoscopic colon cancer surgery can effectively reduce postoperative pain while maintaining perioperative safety.
Omentopexy/Gastropexy (OP/GP) Following Sleeve Gastrectomy Might be an Effective 2-in-1 Method (Reinforcement and Fixation): A Meta-Analysis of 14 Studies and a Call for Randomized Controlled Trials
Authors: Diab Abdul-Rahman Fadi , Alfieri Sarah , DeBlieux Paige , Williams Ashley , Docimo Salvatore , Sujka Joseph Adam , DuCoin Christopher Garnet
Published: September 2023

Background:

Laparoscopic sleeve gastrectomy can lead to dangerous complications as leaks and hemorrhage. In addition, it can lead to gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD). We aimed to study the efficacy of omentopexy/gastropexy (OP/GP) in the prevention of these postoperative complications.

Materials and Methods:

PubMed and Google Scholar were queried in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was analyzed using the Review Manager (RevMen) 5.4.1 software. Mantel-Haenszel statistical method and random effects analysis model were used in all meta-analyses. The odds ratio was used for dichotomous data. Subgroup analysis was done according to bougie size. Subgroup analysis according to the distance between the starting point of gastric transection and pylorus was not possible (limitation). Odds ratio and control event rate across studies were used to calculate the number needed to treat (NNT) with OP/GP for an additional beneficial outcome (prevention of adverse outcome) to occur.

Results:

The initial search identified 442 records; 371 were found irrelevant after screening and were excluded. The remaining 71 reports were retrieved and assessed for eligibility. An additional 57 reports were excluded following an in-depth assessment. The remaining 14 studies were included in this meta-analysis; 8 were nonrandomized studies (NRSs) while 6 were randomized controlled trials. Most studies originated from a single country (limitation). A statistically significant decrease in favor of OP/GP was observed for all outcomes (bleeding, leaks, gastric twist/torsion, prolonged PONV 1 month postoperatively, and postoperative de novo GERD). Data was consistent across studies (low I
2), and subgroup analysis according to bougie size revealed no subgroup differences. However, this study had 3 limitations that does not allow for strong conclusions.

Conclusions:

Although the current literature lacks strong scientific evidence, this study suggests that omentopexy/gastropexy (OP/GP) may offer protection against bleeding and leaks as a staple line reinforcement method, as well as against gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD) as a staple line fixation method. Therefore, it is worthwhile to proceed with large-scale, multicenter, randomized controlled trials to reevaluate our findings. Furthermore, conducting a comparison between OP/GP and other staple line reinforcement techniques would be beneficial.
Traditional Chinese medicine for age-related macular degeneration: A clinical evidence map between 2000 and 2022
Authors: Li Yamin , Liang Lina , Gao Yun , Xu Kai , Zhou Wei , Li Jiaxian , Jin Yu , Huang Ziyang , Li Xiaoyu
Published: September 2023

Background

We systematically searched and summarized clinical studies on traditional Chinese medicine (TCM) for age-related macular degeneration (AMD) with the method of evidence map. We aimed to provide evidence and research direction for the prevention or treatment of AMD with TCM in the future.

Materials and methods

We searched PubMed, Web of Science, EMBASE, and Chinese databases including CNKI (Chinese National Knowledge Infrastructure), WanFang and VIP, Clinical Trials.gov, and Chinese Clinical Trial Registry Center studies on the prevention or treatment of TCM for AMD from January 2000 to November 2022. We showed distribution features of these studies in the form of text description, graphs, and tables.

Results

The final 258 articles included 245 clinical studies, 9 systematic reviews or meta-analyses, and 4 guidelines, expert consensus, or clinical pathway. After analyzing the articles with a focus on the stage of AMD, study type, sample size, intervention measures, outcome indicators, and the quality of evidence, we found that the studies were increasing, most of which were wet AMD, the main study type was randomized controlled trials, and the sample size was mostly fewer than 100 cases. Different interventions of TCM, such as Chinese medicine, Chinese patent medicine, or acupuncture, showed the potential benefits of improving vision, reducing fundus lesions, and alleviating some uncomfortable symptoms. However, the sample size of these studies was small. The outcome indicators were not unified, and the stage of AMD was unclear. The quality of articles was lower, and there were few studies on early AMD. The advantages of TCM for the prevention or treatment of AMD remained unclear.

Conclusions

Early intervention will be the focus and direction of AMD in the prevention or treatment of TCM, and more standardized clinical studies of TCM for early AMD need to be designed and carried out in the future.
Core mechanism and therapeutic methods of aging revealed by qi-collateral theory in traditional Chinese medicine
Authors: Li Hongrong , Hou Yunlong , Lu Xuan , Wang Lu , Li Mengnan , Kang Ning , Wu Yiling
Published: September 2023

Aging, a complex and multisystem process, has increasingly become a hot issue of global concern. Traditional Chinese medicine has accumulated rich understanding of aging during thousands of years of development, which provides valuable references for the in-depth study of overall aging. According to the qi-collateral theory in traditional Chinese medicine, essence is the origin of life; qi is the driving force of life; and spirit is the embodiment of life. This theory interprets key scientific issues such as the formation of life, the driving force of life, the function of zang-fu organs, and the spirit and consciousness. Furthermore, it reveals the key mechanism of aging. That is, the deficiency of kidney essence is the root of aging; the loss of vitality is the key of aging; and the depletion of body and spirit is the manifestation of aging. Based on the experience of medical practitioners in the past dynasties, such as nourishing essence, black food tonifying the kidney, and supplementing essence with flesh-blood products, the treatment method of invigorating kidney and supplementing essence, harmonizing yin and yang, reinforcing the vitality, and nourishing the body and spirit was proposed. Furthermore, an innovative Chinese patent medicine, Bazi Bushen capsules, is developed, which exerts the antiaging effect by replenishing qi, invigorating the spirit, and nourishing the body and spirit. Pharmacological and clinical studies have confirmed that this preparation has antiaging effects and are effective in the prevention and treatment of age-related diseases. Experimental studies have shown that Bazi Bushen capsules can delay the overall aging, reduce the DNA methylation and extend the healthy life of naturally aging mice, mitigate the age-related cognitive dysfunction, improve neurological function, maintain redox homeostasis and telomere integrity, and inhibit apoptosis. Moreover, Bazi Bushen capsules can increase the dermal thickness and the collagen fiber and elastic fiber content to prevent skin aging. In addition, Bazi Bushen capsules can correct the lipid metabolism disorders and ameliorate multisystem age-related diseases such as osteoporosis in surgically induced menopausal rats. This article discusses the pathogenesis, treatment, and prescription of aging and the antiaging theory, aiming to provide a basis for delaying aging and preventing related diseases.
A population-based study on hyperinsulinaemia and arterial stiffness in men with and without abdominal aortic aneurysm
Authors: Fatemi Shahab , Acosta Stefan , Zarrouk Moncef , Nilsson Peter M. , Gottsäter Anders
Published: September 2023

Objectives

Patients with type 2 diabetes mellitus (DM) run lower risk for abdominal aortic aneurysm (AAA, aortic diameter ≥ 30 mm) and its complications. We aimed to evaluate associations between disturbances in glucose metabolism and arterial stiffness, AAA, and abdominal aortic diameter in 65-year-old men.

Methods

Forty-eight 65-year-old men with screening-detected AAA and 115 men with normal abdominal aortic diameter underwent examination of glucose metabolism and arterial stiffness.

Results

Men with AAA had higher BMI, waist-hip ratio (WHR), frequency of DM, haemoglobin A1c, smoking exposure, and plasma insulin levels at 0, 60 and 120 min during OGTT compared to those without. The increase in p-insulin (P < 0.001) after OGTT was also higher in men with AAA, adjusted for smoking, WHR, and nadir value of p-insulin. In analyses adjusted for smoking, use of lipid-lowering agents, and WHR, the increase in p-insulin at 2-hours (P = 0.006) after OGTT and p-homocysteine were associated with abdominal aortic diameter. There were no differences between groups in aortic stiffness or skin autofluorescence Advanced Glycation End products.

Conclusion

In this population-based study hyperinsulinaemia as a marker of insulin resistance, but not hyperglycaemia or aortic stiffness, was associated with AAA and abdominal aortic diameter in 65-year-old men.
Pseudomonas benzopyrenica sp. nov., isolated from soil, exhibiting high-efficiency degradation of benzo(a)pyrene
Authors: Dong Xingchen , Rao Zihuan , Wu Siyi , Peng Fang , Xie Zhixiong , Long Yan
Published: September 2023

A Gram-negative, yellow-pigmented, aerobic and rod-shaped bacterium, designated as strain BaP3T, was isolated from the soil. Strain BaP3T grew at 16–37℃ (optimum, 30 °C) and pH 6.0–8.0 (optimum, pH 7.0). Additionally, strain BaP3T could tolerate NaCl concentrations in the range 0–6 % (optimum, 1%). Moreover, strain BaP3T was motile by flagella. The phylogenetic analysis of 16S rRNA sequences showed that strain BaP3T belonged to the genus

Pseudomonas

, and the sequence was most closely related to

Pseudomonas oryzihabitans

CGMCC 1.3392T and

Pseudomonas psychrotolerans

DSM 15758T, with 99.66 % sequence similarity.

Pseudomonas rhizoryzae

RY24T was the next closely related species, exhibiting 99.38 % 16S rRNA gene sequence similarity. The DNA–DNA hybridization and average nucleotide identity values between strain BaP3T and its closely related types were below 50 and 92 %, respectively. Both results were below the cut-off for species distinction. The genomic DNA G+C content of strain BaP3T was 65.30 mol%. The predominant quinone in strain BaP3T was identified as ubiquinone Q-9. The major cellular fatty acids were summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c), summed feature 3 (C16 : 1
 ω7c and/or C16 : 1
 ω6c) and C16 : 0. These results indicated that strain BaP3T represents a novel species in the genus

Pseudomonas

. The type strain is BaP3T (CCTCC AB 2022379T=JCM 35914T), for which the name Pseudomonas benzopyrenica sp. nov. is proposed.