bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Invasive Arterial Blood Pressure Monitoring vs. Non-Invasive Blood Pressure Monitoring in Preterm Infants < 37 Weeks in the Neonatal Intensive Care Unit— A Prospective Observational Study
Authors: Shah Sachin , Kaul Amita , Khandare Jayant , Dhalait Saleha
Published: December 2021

Background

Accurate measurement of blood pressure (BP) is extremely important in the management of sick preterm newborns. The primary objective of this study was to compare non-invasive blood pressure measurement (NIBP) with invasive blood pressure measurement (IBP) using peripheral arterial cannulation (PAC) in preterm neonates < 37 weeks in the neonatal intensive care unit.

Methods

Preterm neonates needing PAC were prospectively enrolled in the study. NIBP measurements were taken in the same limb as that of peripheral arterial line. Initially IBP was recorded followed by NIBP within 1 min using the same monitor. These were called as paired measurements since they are taken within 1 min of each other.

Results

Seventy-three preterm infants with 1703 paired measurements were included in the final analysis (median gestational age 32 weeks, IQR 30–34 weeks, median birth weight 1540 g, IQR 1160–2100 g). In preterm infants not receiving vasoactive agents (n = 51, 1428 paired measurements, Bland–Altman analysis for agreement between invasive mean blood pressure (MBP) and non-invasive mean BP revealed a bias of −2.9123 mmHg (SD 7.8074). The 95% limits of agreement were from −18.2157 to 12.3893 mmHg. In preterm infants with hypotension, we detected a bias of −3.9176 mmHg (SD 5.1135) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from −13.9401 to 6.1048 mmHg. In normotensive preterm infants receiving vasoactive agents, we detected a bias of −0.7629 mmHg (SD 8.0539) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from −16.5485 to 15.02274 mmHg.

Conclusions

There is poor level of agreement between IBP and NIBP measurements in sick preterm neonates, leading to overestimation or underestimation of blood pressure. The bias was less for mean BP measurements as compared with systolic BP measurements and also for normotensive neonates as compared with hypotensive neonates. Hence, NIBP may be used as a screening method in haemodynamically stable preterm infants, but infants who are haemodynamically unstable and need to be commenced on vasoactive agents should have IBP monitoring.
Proposal for a Treatment-oriented Classification System for Congenital Kyphosis in Children
Authors: Yao Ziming , Guo Dong , Zhang Xuejun , Cao Jun , Liu Haonan , Gao Rongxuan
Published: December 2021

Study Design.

Proposal of a new classification system for pediatric congenital kyphosis.

Objective.

To propose a new treatment-oriented classification system for pediatric congenital kyphosis based on radiographic findings and evaluates the reliability of this new classification system.

Summary of Background Data.

The classification of congenital kyphosis described by Winter is the one most commonly used. However, this classification of congenital kyphosis cannot direct the surgical options and the treatment choices remain controversial.

Methods.

For each type of congenital kyphosis, we propose a set of radiological criteria that are suggestive for diagnosis as well as the corresponding surgical options. To evaluate the reliability of this new classification system, 35 patients with congenital kyphosis were reviewed and classified by four attending spine surgeons and five spine fellows.

Results.

Our new classification system divides congenital kyphosis into five types. The overall Fleiss kappa coefficient (κ) value for the new classification system was 0.755, which indicates significant agreement. The interobserver and intraob-server κ values were 0.755 and 0.828, respectively, and there were no significant differences in the k values between the attending spine surgeons and spine fellows.

Conclusion.

The proposed classification system provides clear descriptions and surgical options for various types of pediatric congenital kyphotic deformities. The reliability study confirmed that the classification system is both simple and consistent, although further research may be needed to validate the system.
Automated Differentiation Between Osteoporotic Vertebral Fracture and Malignant Vertebral Fracture on MRI Using a Deep Convolutional Neural Network
Authors: Yoda Takafumi , Maki Satoshi , Furuya Takeo , Yokota Hajime , Matsumoto Koji , Takaoka Hiromitsu , Miyamoto Takuya , Okimatsu Sho , Shiga Yasuhiro , Inage Kazuhide , Orita Sumihisa , Eguchi Yawara , Yamashita Takeshi , Masuda Yoshitada , Uno Takashi , Ohtori Seiji
Published: December 2021

Study Design.

Retrospective study of magnetic resonance imaging (MRI).

Objectives.

To assess the ability of a convolutional neural network (CNN) model to differentiate osteoporotic vertebral fractures (OVFs) and malignant vertebral compression fractures (MVFs) using short-TI inversion recovery (STIR) and T1-weighted images (T1WI) and to compare it to the performance of three spine surgeons.

Summary of Background Data.

Differentiating between OVFs and MVFs is crucial for appropriate clinical staging and treatment planning. However, an accurate diagnosis is sometimes difficult. Recently, CNN modeling—an artificial intelligence technique—has gained popularity in the radiology field.

Methods.

We enrolled 50 patients with OVFs and 47 patients with MVFs who underwent thoracolumbar MRI. Sagittal STIR images and sagittal T1WI were used to train and validate the CNN models. To assess the performance of the CNN, the receiver operating characteristic curve was plotted and the area under the curve was calculated. We also compared the accuracy, sensitivity, and specificity of the diagnosis made by the CNN and three spine surgeons.

Results.

The area under the curve of receiver operating characteristic curves of the CNN based on STIR images and T1WI were 0.967 and 0.984, respectively. The CNN model based on STIR images showed a performance of 93.8% accuracy, 92.5% sensitivity, and 94.9% specificity. On the other hand, the CNN model based on T1WI showed a performance of 96.4% accuracy, 98.1% sensitivity, and 94.9% specificity. The accuracy and specificity of the CNN using both STIR and T1WI were statistically equal to or better than that of three spine surgeons. There were no significant differences in sensitivity based on both STIR images and T1WI between the CNN and spine surgeons.

Conclusion.

We successfully differentiated OVFs and MVFs based on MRI with high accuracy using the CNN model, which was statistically equal or superior to that of the spine surgeons.

Level of Evidence: 4
Clinical Features and Prognoses of Middle-Aged Women With ST-Elevation Myocardial Infarction With a Focus on Spontaneous Coronary Artery Dissection
Authors: Almasi Aliasghar , Mansouri Pejman , Jameie Mana , Yadangi Somayeh , Parapary Saeed Haghighi , Mohsenizadeh Seyed Abolfazl , Jamshidi Peiman , Jenab Yaser
Published: December 2021

Background:

Spontaneous coronary artery dissection (SCAD) has become an increasingly recognized cause of acute coronary syndrome, particularly in young women, over the last decade. The goal of this study was to determine the prognoses and characteristics of adult women with SCAD who presented with ST-elevation myocardial infarction (STEMI).

Methods:

This retrospective cohort study enrolled all adult women under the age of 60 who had undergone coronary artery angiography in the setting of STEMI. The patients were divided into 3 groups based on their angiographic characteristics: STEMI-SCAD (STEMI due to SCAD), STEMI-ATH (STEMI caused by an atherosclerotic lesion), and STEMI-others (STEMI due to other etiologies including Takotsubo cardiomyopathy and myopericarditis, as well as STEMI despite a normal epicardial coronary angiography).

Results:

Fifteen women out of 311 female patients aged below 60 years with STEMI were diagnosed with SCAD (4.8%). There were no significant differences in body mass index, hypertension, dyslipidemia, smoking status, opium addiction status, family history, previous percutaneous coronary intervention, coronary artery bypass grafting, and cerebrovascular accidents between the STEMI-SCAD and STEMI-ATH groups. Nevertheless, the STEMI-SCAD and STEMI-others groups were more likely to be younger, less likely to be diabetic, and less likely to have 3 cardiovascular risk factors or more than was the STEMI-ATH group. The left anterior descending artery was the most common culprit lesion in the STEMI-SCAD group (80%) and the other 2 groups. Out of the 311 patients, 7 patients died during the index hospitalization: 1 patient in the STEMI-SCAD group, 6 patients in the STEMI-ATH group, and 0 patients in the STEMI-others group. None of the patients in the STEMI-others group experienced any major adverse cardiac events during the follow-up. In the other 2 groups, the most experienced outcomes were myocardial infarction and in-hospital cardiac death, followed by target lesion revascularization and target vessel revascularization.

Conclusions:

STEMI-SCAD is one of the known causes of STEMI in young women. Still, despite the complexity of revascularization in our patients with STEMI-SCAD, they had more favorable prognoses in both conservative and revascularization management modalities than our patients with STEMI-ATH.
Efficacy of Selective Laser Trabeculoplasty on Circadian Intraocular Pressure Following Trabeculectomy in Advanced Primary Open-angle Glaucoma
Authors: Pillunat Karin R. , Herber Robert , Wolfram Stephanie , Jasper Carolin S. , Waibel Soeren , Pillunat Lutz E.
Published: December 2021

Précis:

In about 50% of post-trabeculectomy (TE) eyes, selective laser trabeculoplasty (SLT) is effective in further lowering intraocular pressure (IOP).

Purpose:

To investigate the efficacy and safety of SLT in post-TE eyes, uncontrolled on maximum tolerated medication, and/or with progression of visual field loss.

Patients and Methods:

This retrospective study consecutively included post-TE eyes of patients diagnosed with primary open-angle glaucoma who had been treated with 360 degrees SLT and had a follow-up after 12 months. Primary endpoints were the reduction of mean diurnal intraocular pressure (mdIOP, mean of 6 measurements), peak IOP, and diurnal IOP fluctuations. Secondary outcomes were factors influencing IOP reduction, SLT success, and failure rates.

Results:

Forty-three eyes of 43 patients were included. During the first year, 10 eyes (23%) needed additional procedures to reduce mdIOP and were accounted as failures and excluded from final analysis. Of the remaining 33 eyes (77%) mdIOP [Q25, Q75] dropped from 15.2 [12.2 to 16.5] to 13.2 [11.6 to 15.3] mm Hg (P=0.027), 23 eyes (54%) showed a sufficient mdIOP reduction, 1 year after SLT.

Conclusion:

SLT is effective and safe in lowering mdIOP to target IOP in about 50% of eyes after prior incisional glaucoma surgery.
Use of Benzodiazepines and Antipsychotic Drugs Are Inversely Associated With Acute Readmission Risk in Schizophrenia
Authors: Strømme Maria F. , Mellesdal Liv S. , Bartz-Johannesen Christoffer A. , Kroken Rune A. , Krogenes Marianne L. , Mehlum Lars , Johnsen Erik
Published: December 2021

Purpose

Little is known about the impact of different psychotropic drugs on acute readmission risk, when used concomitantly in a real-life setting. We aimed to investigate the association between acute readmission risk and use of antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines in patients with schizophrenia.

Methods

A cohort study included all patients diagnosed with schizophrenia admitted to a psychiatric acute unit at Haukeland University Hospital in Bergen, Norway, during a 10-year period (N = 663). Patients were followed from discharge until first readmission or censoring. Cox multiple regression analyses were conducted using antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines as time-dependent variables, and periods of use and nonuse were compared within individual patients. Adjustments were made for sex, age at index admission, and excessive use of alcohol and illicit substances.

Results

A total of 410 patients (61.8%) were readmitted during follow-up, and the mean and median times in days to readmission were 709 and 575, respectively. Compared with nonuse, the use of antipsychotic drugs was associated with reduced risk of readmission (adjusted hazards ratio, 0.20; P < 0.01; confidence interval, 0.16–0.24), and the use of benzodiazepines was associated with increased risk of readmission (adjusted hazards ratio, 1.51; P < 0.01; confidence interval, 1.13–2.02). However, no relation to readmission risk was found for the use of antidepressants and mood stabilizers.

Conclusions

We found that use of benzodiazepines and antipsychotic drugs are inversely associated with acute readmission risk in schizophrenia.
Leiomyomatosis-like lymphangioleiomyomatosis
Authors: Erginoz Ergin , Taskin Halit Eren , Cavus Gokce Hande , Zengin Abdullah Kagan
Published: December 2021

Introduction:

Tuberous sclerosis complex is an inherited multisystemic disorder with manifestations in various organ systems as a result of a mutation of 1 of 2 tumor suppressor genes, tuberous sclerosis complex-1 or tuberous sclerosis complex-2. Perivascular epithelioid cell tumors have been shown to be associated with these gene mutations and include a variety of tumors such as angiomyolipomas and lymphangioleiomyomatosis.

Patient concerns:

In this report, we present a case of a 28-year-old woman presenting with symptoms of severe abdominal pain and nausea with a medical history of cardiac rhabdomyoma, adenoma sebaceum, Ash leaf spots, bilateral renal angiomyolipomas, and retinal hamartoma, which are manifestations of tuberous sclerosis complex. The patient was operated twice for colonic perforations in the rectosigmoid and ileocecal regions where the pathologic examination revealed multiple tumoral lesions in both specimens.

Diagnosis:

The tumor consisted of a myomatous component where the nodules were composed of spindle cells with fascicular array, and a lymphangiomatous component where epithelioid cells could be observed. Immunohistochemically, smooth muscle markers (desmin and SMA) were positive and the epithelioid component showed HMB-45 positivity. A diagnosis of leiomyomatosis-like lymphangioleiomyomatosis was established due to its morphological and immunohistochemical features, the presence of the tumor in multiple foci, and widespread lymphovascular invasion.

Interventions:

The patient had a perforation in her bowel twice during the hospital stay and underwent Hartmann operation and ileocecal resection in 2 different surgical operations.

Outcomes:

After the second operation the patient developed fever and was diagnosed with SARS-CoV-2 infection. No other complication was observed during her stay and the patient's follow-up was unremarkable.

Conclusion:

Perivascular epithelioid cell tumors are associated with tuberous sclerosis and can rarely appear in the colon. Therefore, lymphangioleiomyomatosis should be in the differential diagnosis in a tuberous sclerosis patient presenting with a colonic tumor.
The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic
Authors: Sommer Guillermo Marcos , Broschewitz Johannes , Huppert Sabine , Sommer Christina Gesine , Jahn Nora , Jansen-Winkeln Boris , Gockel Ines , Hau Hans-Michael
Published: December 2021

Introduction:

Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training.

Methods:

In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities.

Results:

Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training.

Conclusions:

Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.
Non-surgical management of tubal ectopic pregnancy
Authors: Xiao Chao , Shi Qingquan , Cheng Qijun , Xu Jianli
Published: December 2021

Background:

Ectopic pregnancy (EP) is a common cause of acute abdominal pain in the field of gynecology. Because the majority of women with EP are hemodynamically stable, non-surgical therapy is a viable option. The goal of this study was to determine the most effective non-surgical therapy for hemodynamically stable EP.

Methods:

We performed a systematic review and meta-analysis. We searched PubMed, LILACS, SciELO, CINAHL, Embase, and the Cochrane library in May 2020, with no starting date restrictions.Studies were restricted to randomized controlled trials, which were included if the target population contained women with tubal EP and the intervention was non-surgical management. The primary outcome measure was treatment success defined by a decrease in serum hCG to a level ranging from five mIU/mL to 50 mIU/mL. Secondary outcome measures were side effects, time needed to treat, number of injections and operative rate.

Results:

We conducted a meta-analysis of 15 studies that included 1573 women who were diagnosed with EP and managed non-surgically. There was no significant difference in treatment success in the matched groups; however, single-dose MTX was associated with fewer side effects than multiple-dose (relative risk 0.48, 95% confidence interval 0.28–0.80, P = .006) and two-dose therapies (relative risk 0.74, 95% confidence interval 0.55–1.00, P = .05).

Conclusions:

We highly recommend that single-dose MTX without mifepristone be used first-line in patients who require conservative therapy due to the inherent negative effects of mifepristone. An EP woman with a low -hCG level that is falling or plateauing should receive expectant treatment to reduce adverse effects.
Identification of prognostic metabolic genes in adrenocortical carcinoma and establishment of a prognostic nomogram
Authors: Chen Qing , Ren Ziyu , Liu Dongfang , Jin Zongrui , Wang Xuan , Zhang Rui , Liu Qicong , Cheng Wei
Published: December 2021

Adrenocortical carcinoma is an invasive malignancy with poor prognosis, high recurrence rate and limited therapeutic options. Therefore, it is necessary to establish an effective method to diagnose and evaluate the prognosis of patients, so as to realize individualized treatment and improve their survival rate.

This study investigated metabolic genes that may be potential therapeutic targets for Adrenocortical carcinoma (ACC). Level 3 gene expression data from the ACC cohort and the relevant clinical information were obtained from The Cancer Genome Atlas (TCGA) database. To verify, other ACC datasets (GSE76021, GSE19750) were downloaded from the Gene Expression Omnibus (GEO) database. The ACC datasets from TCGA and GEO were used to screen metabolic genes through the Molecular Signatures Database using gene set enrichment analysis. Then, the overlapping metabolic genes of the 2 datasets were identified.

A signature of five metabolic genes (CYP11B1, GSTM2, IRF9, RPL31, and UBE2C) was identified in patients with ACC. The signature could be used to divide the patients with ACC into high- and low-risk groups based on their median risk score. Multivariate Cox regression analysis was performed to determine the independent prognostic factors of ACC. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to assess the prediction accuracy of the prognostic signature. Last, a nomogram was established to assess the individualized prognosis prediction model.

The results indicated that the signature of 5 metabolic genes had excellent predictive value for ACC. These findings might help improve personalized treatment and medical decisions.
Effect of antidepressants in pregnancy outcomes
Authors: Hlongwane Rixile , Phoswa Wendy N.
Published: December 2021

Background:

Depression is much more common in women pre their pregnancies with antidepressants use less common which is caused by when many patients opt to discontinue with the use due to its side effects it causes. But whether depression is treated by antidepressants or not this has the same negative pregnancy outcomes on both the mother and the unborn and even born child from these mothers.

Methods:

Information will be retrieved for this systematic review and meta-analysis study on antidepressants use pregnancy outcomes from PubMed and Google scholar search engines using search medical subjects headings on PubMed and the PICOS framework as the determinant of the research question. All returned articles searched will be stored to Zotero.org and the software RevMan will be used to analyze data.

Ethics and dissemination:

The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. In addition, findings from this study will assist in assessing health related risk outcomes of antidepressants during- and postpregnancy on both the fetal and mother either when used pre- and during-pregnancy.

Systematic review registration:

International prospective Register of Systematic Reviews (PROSERO) number: CRD42021232111.
Chinese medicinal herbs for idiopathic membranous nephropathy in adults with nephrotic syndrome
Authors: Liu Meifang , Yang Qianchun , Hua Qiaoli , Liu Jialing , He Weifeng , Niu Di , Liu Xusheng
Published: December 2021

To assess the benefits and harms of Chinese medicinal herbs formulae for the treatment of idiopathic membranous nephropathy in adult patients with primary nephrotic syndrome.

Only randomized controlled trials were included. We searched the Cochrane Central Register of Controlled Trials database, PubMed, EMBASE, Chinese National Knowledge Internet, Chinese Biomedicine Database, and VIP. All studies were analyzed using the criteria of the Cochrane Handbook and were assessed in terms of quality and the risk of bias. Review Manager ver. 5.3.5 software was used for the data analysis, and GRADE profiler software was employed to evaluate quality.

Two studies were included (n = 126 Chinese participants). We found that compared with against conventional treatment, one Chinese medicinal herbs formula plus conventional treatment reduced 24-hours urinary total protein (mean differences –3.16 g/24 h, 95% confidence intervals –4.03 to –2.29), and two Chinese medicinal herbs formulae increased serum albumin levels (mean differences 3.18 g/L, 95% confidence intervals 1.12 to 5.52; I
2 = 0%).

Chinese medicinal herbs formulae may reduce 24-hours urinary total protein and increase serum levels of albumin. However, larger and multicenter studies with high methodological quality are still needed.
Malignant pancreatic tumor other than solid pseudopapillary tumor in pediatric patients
Authors: Kim Duon , Yang Hee-Beom , Kim Hyun-Young
Published: December 2021

Pancreatic tumors, except solid pseudopapillary tumors (SPTs), are rare in pediatric patients. Herein, we report various types of pancreatic tumors in pediatric patients and review the literature regarding their treatments and prognosis.

We retrospectively reviewed the data of pediatric patients who underwent surgery for pancreatic tumors, excluding SPTs, between January 2009 and December 2019 at Seoul National University Children's Hospital. A total of 35 pediatric patients were identified as having undergone surgery for pancreatic tumors. Of these patients, 30 were excluded because the tumor was identified as an SPT.

The diagnoses of the five remaining (non-SPT) pancreatic tumors were pancreatic neuroendocrine tumor, mixed acinar neuroendocrine carcinoma, kaposiform hemangioendothelioma, and intraductal papillary mucinous neoplasm. All five patients survived; however, recurrence and liver metastasis were observed in one patient. The detailed demographics, treatments, and prognosis of each patient were reviewed.

Despite the rarity and lowincidence of pancreatic tumors in pediatric patients, four types of non-SPT tumors are reported here. Hence, the possibility of these should not be overlooked, especially since the diagnosis and adjuvant treatment differ vastly between the tumor types.
Is there a relationship between body mass index and postoperative pain scores in thoracotomy patients with thoracic epidural analgesia?
Authors: Zengin Musa , Ulger Gulay , Baldemir Ramazan , Sazak Hilal , Alagoz Ali
Published: December 2021

Postoperative efficacy of thoracic epidural analgesia (TEA) following thoracic surgery may vary in patients with different body mass index (BMI) values, regardless of the success of the method. This study aimed to investigate the effects of BMI on postoperative pain scores in patients who underwent thoracotomy with TEA.

After obtaining the ethical committee approval (Date: May 11, 2021, Number: 2012-KEAK-15/2305) the data of 1326 patients, who underwent elective thoracic surgery in high volume tertiary thoracic surgery center between January 2017 and January 2021, were analyzed retrospectively. Patients between the age of 18 and 80 years, who underwent thoracotomy and thoracic epidural catheterization (TEC), and who were assigned American Society of Anesthesiologists I to III physical status were included to the study. Of the 406 patients, who underwent a successful TEC, 378 received postoperative analgesia for 72 hours. Visual analog scale (VAS) scores of these patients were evaluated statistically. Based on BMI, patients were categorized into the following 5 groups: Group I: BMI < 20 kg/m2, Group II: BMI = 20 to 24.9 kg/m2, Group III: BMI = 25 to 29.9 kg/m2, Group IV: BMI = 30 to 34.9 kg/m2, and Group V: BMI ≥ 35 kg/m2.

There were no statistically significant differences in TEC success across different BMI groups (P > .05). Catheter problems and VAS scores significantly increased with higher BMI values in the postoperative 72-hours period (P < .05). Rates of rescue analgesic use were higher in BMI groups of 30 toto 34.9 kg/m2 and ≥35 kg/m2 compared to the other BMI groups.

This study revealed that higher BMI in patients may increase VAS scores, who administered TEA for pain management following thoracotomy. This correlation was supported by the increased need for additional analgesics in patients with high BMI. Therefore, patients with high BMI values would require close monitoring and follow-up.
A meta-analysis of XRCC1 single nucleotide polymorphism and susceptibility to gynecological malignancies
Authors: Zhang Xue Qin , Li Li
Published: December 2021

Background:

Gynecological malignant tumor is a serious threat to women's health, cervical cancer, endometrial cancer and ovarian cancer are the most common. The eponymous protein encoded by the XRCC1 (X-ray repair cross complementation 1) gene is an important functional protein in the process of single-stranded DNA damage. Non-synonymous mutations of XRCC1 gene cause amino acid sequence changes that affect protein function and DNA repair ability, and may affect the interaction with other DNA repair proteins, leading to increased risk of tumor development. Many studies have assessed the association between XRCC1 gene polymorphism and the risk of cancer in the female reproductive system, but the results have been inconclusive. In this study, the relationship between XRCC1 Arg399Gln, Arg194Trp, Arg280His single nucleotide polymorphisms and susceptibility to gynecological malignancies was further explored by meta-analysis.

Methods:

English database: Pubmed, Medline, Excerpta Medica Database, Cochrance, etc; Chinese database: China national knowledge infrastructure, Wanfang Database, etc. STATA14 was used for statistical analysis, such as odd ratio (OR) value, subgroup analysis, heterogeneity test, sensitivity analysis, and publication bias.

Results:

In gynecologic cancers, the allele frequency difference of Arg399Gln case control group was statistically significant (GvsA: P = .007). There was no significant difference in allele frequency in the Arg194Trp and Arg280His case control groups (P = .065, 0.198). In different gene models, Arg399Gln was significantly correlated with gynecologic cancers susceptibility (GGvs AA: OR 0.91; 95% confidence interval [CI], 0.85 0.98); Arg194Trp was significantly correlated with gynecologic cancers susceptibility (CCvs TT: OR 0.94; 95% CI 0.88,1.00; CCvs CT: OR 0.97; 95% CI 0.90, 1.05); Arg280His was significantly correlated with gynecologic cancers susceptibility (GGvs AA: OR 0.98; 95% CI 0.94, 1.02; GGvs GA: OR 1.00;95% CI 0.97, 1.04). In the subgroup analysis, Arg399Gln and Arg194Trp were significantly correlated with gynecologic cancers susceptibility in the Asian race (P = .000, 0.049). In the analysis of different cancer subgroups, Arg399Gln and cervical cancer susceptibility were statistically significant (P = .039). Arg194Trp and endometrial cancer susceptibility were statistically significant (P = .033, 0.001).

Conclusions:

XRCC1 Arg399Gln, Arg194Trp, Arg280His single nucleotide polymorphisms were associated with gynecologic cancer susceptibility. Arg399Gln genotype was statistically significant in relation to cervical cancer susceptibility. Arg194Trp genotype was statistically significant in relation to endometrial cancer susceptibility.
Efficacy and safety of colonic dialysis combined with traditional Chinese medicine retention enema in the treatment of chronic renal failure
Authors: Wang Zhilei , Zhang Shoulin , Zheng Xue , Zhang Lili
Published: December 2021

Background:

Chronic renal failure (CRF) is a major public health problem worldwide nowadays. It is characterized by a slow reduction in kidney function identified by an increase of serum creatinine levels and a reduction of urine output. CRF is easier to diagnose than to treat. Clinical evidence shows that colonic dialysis combined with traditional Chinese medicine (TCM) enema can treat CRF by reducing serum creatinine. To assess the therapeutic efficacy and safety of colonic dialysis combined with Traditional Chinese medicine retention enema in CRF, we created a protocol for a systematic review to inform future clinical applications.

Methods:

Eligible random controlled trials were collected from 8 bibliographic databases (PubMed, EMBASE, Web of Science, The Cochrane Library, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang Database), completed before October 2021. The primary outcome is the serum creatinine, Urea nitrogen, total effective rate, uric acid, creatinine clearance. Secondary outcome: TCM syndrome score, glomerular filtration rate, hemoglobin, adverse reactions, and adverse events. Data extraction and quality assessment were independently conducted by 2 researchers. The quality and bias of the data were assessed using RevMan5.4 software.

Results:

This study will provide a clinical basis for colonic dialysis combined with TCM retention enema in the treatment of CRF.

Conclusion:

Colonic dialysis combined with TCM retention enema in the treatment of CRF can delay the progression of renal disease, proving its effectiveness and safety.

INPLASY Registration number:

INPLASY2021100116
Neurologic deficit due to vertebral body osteophytes after oblique lumbar interbody fusion
Authors: Lee Tae-Kyu , Kim Jae-Young , Han Moon-Soo , Lee Jung-Kil , Moon Bong Ju
Published: December 2021

Rationale:

In recent years, oblique lumbar interbody fusion (OLIF), which uses a window between the peritoneum and the iliopsoas muscle to split the muscle to access the lumbar spine, is known as an effective and safe treatment for spinal diseases, such as degenerative disc disease, spondylolisthesis, recurrent disc herniation, and spinal deformity. Despite this fast and useful surgical method, there were often cases of new neurological symptoms or worsening of symptoms after surgery. We analyzed the preoperative risk factors in a patient with neurologic symptoms, such as motor weakness and exacerbation of radiating pain, after OLIF.

Patient concerns:

A 78-year-old man presented with complaints of numbness in the soles of both feet. L4–5 stenosis was diagnosed on MRI. We performed bilateral L4 laminotomy and L4–5 percutaneous posterior screw fixation after L4–5 OLIF. Postoperatively, his radiating pain improved, and there were no other neurologic symptoms. In the 6th week after surgery, he complained of pain in both ankles, while in the 10th week, the pain progressively worsened, and there was a decrease in motor performance of the right ankle.

Diagnosis:

Magnetic resonance imaging findings indicated that L4–5 stenosis was resolved. On the basis of the computed tomography findings, the cage was well inserted, the disc height and foramen height increased, and the alignment was good. However, a nerve root injury due to the protruding osteophyte from the inferior endplate of the L4 body was suspected, necessitating exploration of both L4 nerve roots by focusing on the right side.

Interventions:

We performed right facetectomy and right foraminotomy. During surgery, it was confirmed that the right L4 nerve root was entrapped by the osteophyte.

Outcomes:

Postoperatively, his radiating pain improved, and motor performance of his right ankle was restored.

Lessons:

A prominently protruding osteophyte is assessed as a possible risk factor for the development of new neurologic deficits after OLIF. In patients with confirmed osteophytes, surgery should be planned taking into consideration the shape of the osteophytes and their relationship to the nerve root.
Prevalence of SARS-CoV-2 amongst ophthalmologists throughout the first and second waves of the pandemic
Authors: Sacchi Matteo , Lizzio Rosario Alfio Umberto , Villani Edoardo , Tagliabue Elena , Monsellato Gianluca , Pajardi Giorgio , Luccarelli Saverio , Nucci Paolo
Published: December 2021

The study aims to investigate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among ophthalmology unit staff throughout the first and second waves of the outbreak, in order to verify the effectiveness of the measures adopted in containing the contagion.

A retrospective observational study was conducted involving staff members, who received a naso/oropharyngeal swab when complaining of SARS-CoV-2 symptoms and once a month as a screening measure. They were tested for SARS-CoV-2 antibodies as a screening measure during the first and the second wave. Clinical activities performed during the outbreak were compared with those performed during the same period in 2019 and correlated with the number of coronavirus disease-2019 eye care workers.

Analysis included 25 workers. Clinical infection was 0% and 12% whereas the prevalence of SARS-CoV-2 antibodies ranged from 4% to 8% in the first and second wave, respectively. The increase in the prevalence of SARS-CoV-2 infection between the first and the second wave was not significant (1/25 vs 3/25, P = .6092). Clinical activities significantly decreased during the first wave compared with the same period in 2019 (3256 vs 10,075, P < .0001, –68% to 2019), but increased during the second wave (8208 vs 3256, P < .0001, +152% to the first wave).

Despite the increase in routine activities during the second wave, we did not observe a significant increase in SARS-CoV-2 prevalence. Strict protection measures seemed to contain the rate of contagion among the ophthalmology unit members even in a high-volume clinical setting in one of the most affected area by the coronavirus disease-2019 outbreak.
Development and validation of a nomogram for predicting prostate cancer in patients with PSA ≤ 20 ng/mL at initial biopsy
Authors: Wu Qiang , Li Fanglong , Yin Xiaotao , Gao Jiangping , Zhang Xu
Published: December 2021

The aim of this study was to construct a nomogram for predicting prostate cancer (PCa) in patients with PSA ≤ 20 ng/mL at initial biopsy.

The patients with PSA ≤ 20 ng/mL who underwent prostate biopsy were retrospectively included in this study. The nomogram was developed based on predictors for PCa, which were assessed by multivariable logistic regression analysis. The receiver operating characteristic curve, calibration plots and decision curve analysis (DCA) were used to evaluate the performance of the nomogram.

This retrospective study included 691 patients, who were divided into training set (505 patients) and validation set (186 patients). The nomogram was developed based on the multivariable logistic regression model, including age, total PSA, free PSA, and prostate volume. It had a high area under the curve of 0.857, and was well verified in validation set. Calibration plots and DCA further validated its discrimination and potential clinical benefits. Applying the cut-off value of 15%, our nomogram would avoid 42.5% of unnecessary biopsies while miss only 4.4% of PCa patients.

The nomogram provided high predictive accuracy for PCa in patients with PSA ≤ 20 ng/mL at initial biopsy, which could be used to avoid the unnecessary biopsies in clinical practice.
Case report of gastric syphilis in Korea
Authors: Yu Hyung-Joo , Kim Seong-Jung , Oh Hyung-Hoon , Im Chan-Mook , Han Bora , Myung Eun , Yun Sook-Jung , Lee Kyung-Hwa , Joo Young-Eun
Published: December 2021

Rationale:

Syphilis is a contagious infectious disease caused by Treponema pallidum. Gastric involvement of syphilis is rare and has nonspecific gastrointestinal symptoms and endoscopic findings. To date, 16 cases have been reported in Korea. Here, we report 2 additional cases of gastric syphilis in men in their 30 second.

Patients concerns:

Two 35- and 33-year-old men presented with epigastric pain.

Diagnosis:

The serum venereal disease research laboratory and fluorescent treponemal antibody absorption tests were positive. Esophagogastroduodenoscopy showed multiple variable-sized flat elevated lesions and geographic ulcers with whitish exudates in the antrum and body. Warthin–Starry silver staining of endoscopic biopsy specimens confirmed gastric syphilis.

Interventions:

The patients were treated with an intramuscular injection of 2.4 million units of benzathine penicillin once a week for 3 weeks.

Outcomes:

Clinical symptoms and gastric lesions were completely resolved.

Lessons:

First, gastric syphilis, despite its rarity and nonspecific symptoms and endoscopic findings, should be considered in a rare extracutaneous presentation of syphilis. Second, a high index of clinical suspicion and an accurate diagnosis based on a combination of clinical, radiological, endoscopic, serologic, and histopathologic findings provide an opportunity to identify and treat patients with gastric syphilis.
Recurrent pulmonary cryptococcosis during chronic HBV infection
Authors: Liu Huan , Shen Shu , Wang Qiuhui
Published: December 2021

Rationale:

Pulmonary cryptococcosis is one of the important opportunistic infections and has a wide range of symptoms depending on the underlying conditions. Here, we reported a case living with chronic hepatitis B virus infection who had a recurrent pulmonary cryptococcosis.

Patient concerns:

A 51-year-old male patient was admitted to our center because of cough, fatigue, and shortness of breath for 2 weeks.

Diagnosis:

Pulmonary infection was suggested by chest computed tomography. Most lab examinations for infection were negative and only cryptococcal antigen testing was positive. Therefore, a clinical diagnosis of pulmonary cryptococcosis was made.

Interventions:

Fluconazole (200 mg/day) and bicyclol (50 mg/day) was given orally.

Outcomes:

During the follow-up of 3 and 6 months, his conditions improved, and he recovered fully. Moreover, cryptococcal antigen level was 12.57 ng/mL. During the 2-year follow-up, no recurrence occurred.

Lessons:

This case highlights the importance of the awareness of opportunistic infections during chronic hepatitis B virus infection, especially the potential of recurrence.
A case report of ovarian granulosa cell tumor in patient with polycystic ovarian syndrome
Authors: Kim Yun S. , Lee Ji H.
Published: December 2021

Rationale:

Granulosa cell tumors (GCTs) account for less than 2% of all ovarian malignancies and are the second most common ovarian sex cord stromal tumors after fibroma/thecomas.

GCTs occur most frequently in postmenopausal women with a peak age of 50 to 55, are usually diagnosed in their early stages, and have a good prognosis. GCTs usually present with features of hyperestrogenism, with an average size is 10 to 15 cm.

Patient concerns:

A 31-year-old nulligravida diagnosed with polycystic ovarian syndrome (PCOS) 10 years prior, had a 20-mm mass in her right ovary found on ultrasonography 2 years ago. She had been taking dienogest 2 mg for 2 years for a misdiagnosed endometrioma, but over a 2-year course, the mass increased to 50 mm.

Diagnoses:

An ultrasound scan revealed a 47 × 37-mm round solid mass in the right ovary with a spongiform appearance and little vascularity. The pathologic findings showed an adult-type granulosa cell tumor with necrosis and hemorrhage. The tissue stained positive for inhibin-α, Wilms’ tumor-1, CD56, and negative for cytokeratin 7.

Interventions:

We finally performed right salpingo-oophorectomy, endometrial biopsy, peritoneal biopsy, and partial omentectomy. The pathological findings were adult-type granulosa cell tumor. The International Federation of Gynecology and Obstetrics staging was IA. The patient did not require additional treatment.

Outcomes:

Surprisingly, her normal menstruation returned 2 weeks after the operation, and she had a normal pregnancy and parturition. The patient had been followed-up regularly for 3 years following the surgery. The patient has not experienced any complications and has remained disease-free.

Lessons:

GCTs should be considered in the differential diagnosis if a female patient with PCOS and amenorrhea shows a unilateral small solid mass. They are extremely rare malignant ovarian tumors that must be differentiated from other benign ovarian tumors, especially endometriomas and dermoid cysts. It was difficult for us to suspect a granulosa cell tumor because the patient already had PCOS symptoms such as mild hirsutism and amenorrhea. This case highlights the importance of physicians being aware of and suspicious for GCTs in similar cases, along with knowing their characteristics in considering possible differential diagnoses.
Danning tablets might improve glucose and lipid metabolism in asymptomatic T2MD patients after cholecystectomy
Authors: Chen Weijie , Zhou Shengnan , Xiao Jianchun , Liu Wei , Qu Qiang , He Xiaodong
Published: December 2021

Considering the role of bile acids in glucose metabolism and the effect of farnesoid X receptor agonists on bile acids, we investigated the possible effect of Danning tablets (DNTs), a type of farnesoid X receptor agonist, on glucose and lipid metabolism in asymptomatic type 2 diabetes mellitus (T2DM) patients.

A series of asymptomatic T2DM patients who underwent cholecystectomy at least 2 years prior and were regularly followed up in our hospital were included in our analysis. According to their choice, they were divided into 2 groups: the DNT group and the control group. Demographic data, body weight, food intake, effects on diabetes control, and biomedical variables were collected.

After propensity score matching, a total of 64 T2DM patients (41 males and 23 females) were included in the analysis. The amount of daily food intake (kcals) and diet composition were little changed 6-months after DNT administration (P = .612). However, the average fasting glucose level of the DNT group decreased from 9.5 ± 1.4 mmol/L to 8.3 ± 1.6 mmol/L (P < .001), and the level of hemoglobin A1c decreased from 8.3 ± 1.1% to 7.6 ± 1.0% (P = .001). The total cholesterol level (P = .024) and low-density lipoprotein cholesterol level (P = .034) decreased significantly (P = .018). Moreover, the average level of total bile acids decreased from 6.05 ± 2.60 μmol/L to 5.10 ± 1.83 μmol/L in the DNT group (P = .037), and the level of glucagon-like peptide-1 significantly increased from 6.93 ± 4.94 pmol/L to 11.25 ± 5.88 pmol/L (P < .001).

The results of our study show that DNT intake improved glucose and lipid metabolism and increased the level of glucagon-like peptide-1.

Trial registration: registered in Chinese Clinical Trial Registry (No. ChiCTR1900027823).
Epidemiology of Meckel's diverticulum: A nationwide population-based study in Taiwan
Authors: Chang Yu-Chuan , Lai Jung-Nien , Chiu Lu-Ting , Wu Meng-Che , Wei James Cheng-Chung
Published: December 2021

The diverse presentation of Meckel's diverticulum (MD) is a diagnostic challenge for clinicians and most previous studies consist of single institutional case series. The aim of this study was to review the related diagnoses of MD and to investigate the epidemiological characteristics using Taiwan's National Health Insurance Research Database.

We conducted an observational study using a population-based database. Patients diagnosed with MD who concurrently received intestinal surgery were identified. We analyzed the patients’ demographic characteristics and relevant diagnoses using χ
2 test and 2-sample t test.

We identified 2453 newly diagnosed MD patients from 1996 to 2013 and 1227 patients (50%) with intestinal obstruction, gastrointestinal bleeding, and acute appendicitis (acute abdominal pain) were defined as symptomatic. The male to female ratio was 2.4:1 with half of the patients experiencing symptomatic MD before the age of 20 years’ old. The age-specific and annual incidence were calculated for all MD and symptomatic MD. Among the symptomatic MD patients, intestinal obstruction was present in 583 (48%), acute appendicitis was present in 464 (38%), and gastrointestinal bleeding was present in 283 (23%) patients. Intestinal obstruction was the most common preoperative diagnosis in the 0 to 10 years and >20 years’ age groups, and acute appendicitis (acute abdominal pain) was the most common diagnosis in the 11 to 20 years’ age group.

This population-based 18 years’ epidemiologic study described the distributions of MD symptoms among different age groups, which may help clinicians gain a better understanding of this diagnostically challenging gastrointestinal anomaly.