bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibody prevalence and immunotherapy response in Chinese patients with epilepsy and encephalopathy scores for patients with different neuronal surface antibodies
Authors: Jia Yu , Wang Hui-Fang , Zhang Meng-Yao , Wang Yu-Ping
Published: December 2021

Background:

The scale assessment was helpful in predicting the presence of antibodies to autoimmune encephalitis. This study aimed to evaluate the application of antibody prevalence in Chinese patients with epilepsy and encephalopathy (APE2-CHN) and response to immunotherapy in Chinese patients with epilepsy and encephalopathy (RITE2-CHN) for patients with different neuronal surface antibodies.

Methods:

A total of 1365 patients with epileptic seizures as the prominent feature in Xuanwu Hospital, Capital Medical University, from June 2016 to June 2020 were enrolled in our study. Of these, 915 patients with epilepsy of unknown etiology whose serum and/or cerebrospinal fluid samples were examined for autoimmune antibodies were selected. All patients were scored with antibody prevalence in patients with epilepsy and encephalopathy (APE2), response to immunotherapy with epilepsy and encephalopathy (RITE2), APE2-CHN, and RITE2-CHN scores.

Results:

Of the 915 patients, 191 patients were positive for neural-surface specific antibodies (115 N-methyl-D-aspartate receptor (NMDAR) Ab, 47 leucine-rich glioma-inactivated protein 1 (LGI1) Ab, 8 contactin-associated protein 2 (CASPR2) Ab, 4 AMPA2R-Ab, and 11 GABAR-B-Ab; 3 CASPR2-Ab and LGI1-Ab, 2 NMDAR-Ab and CASPR2-Ab, and 1 NMDAR-Ab and myelin-oligodendrocyte glycoprotein [MOG] Ab). The sensitivity and specificity of APE2 ≥4 in predicting the presence of neural-surface specific antibodies in our study were 74.35% and 81.77%, respectively, and the sensitivity and specificity of APE2-CHN ≥4 were 75.92% and 84.53%, respectively. Eight cases had an APE2 score <4 and APE2-CHN score ≥5; all these patients had memory decline as the prominent manifestation. We divided the patients into six groups according to the different antibodies. APE2-CHN scores showed higher sensitivity for the prediction of NMDAR-Ab, but lower sensitivity for LGI1-Ab. A total of 187/191 (97.91%) patients received immunotherapy and 142/191 (74.35%) patients benefited from the treatments. The patients who were positive for LGI1-Ab with RITE2-CHN ≥8 responded well to immunotherapy.

Conclusions:

APE2-CHN had the highest value for predicting the positivity of NMDAR-Ab and RITE2-CHN evaluated the response of immunotherapy for anti-LGI1 encephalitis appropriately. However, RITE2 and RITE2-CHN do not appear to be good predictors of immunotherapy outcomes for patients with specific neuronal-surface antibodies and high APE2-CHN scores are often indicative of a poor response to immunotherapy.
Artificial intelligence for diabetic retinopathy
Authors: Li Sicong , Zhao Ruiwei , Zou Haidong
Published: December 2021

Diabetic retinopathy (DR) is an important cause of blindness globally, and its prevalence is increasing. Early detection and intervention can help change the outcomes of the disease. The rapid development of artificial intelligence (AI) in recent years has led to new possibilities for the screening and diagnosis of DR. An AI-based diagnostic system for the detection of DR has significant advantages, such as high efficiency, high accuracy, and lower demand for human resources. At the same time, there are shortcomings, such as the lack of standards for development and evaluation and the limited scope of application. This article demonstrates the current applications of AI in the field of DR, existing problems, and possible future development directions.
Increasing Functional Measurement Tool Utilization by Acute Physical Therapists
Authors: Betts Traci Tiemann , Davis Kristin , Palagonia Christie , Walag Homer B.
Published: December 2021

Background:

At an acute academic medical center, an electronic medical record (EMR) clarity report revealed that proper documentation of a functional measurement tool during acute physical therapy (PT) initial evaluation and reevaluation sessions occurred only 12% of the time. A formal quality improvement project was initiated to correct this gap in recommended best practice.

Objective:

To increase utilization and documentation of functional measurement tools in acute PT evaluation and reevaluation sessions from baseline of 12% to 100% based on the APTA recommendations for best standard of care in clinical practice.

Methods:

This quality improvement project involved acute PT staff and faculty in an academic medical center assessing a gap in best practice. Barriers to best clinical practice were assessed and targeted interventions included education and awareness of baseline performance compared with expectations, streamlining usability of the EMR documentation flowsheet and creating resources to address gaps in knowledge, performance, or access to available functional tools. Data were collected at project initiation, midterm, and after final interventions through manual chart reviews, EMR clarity reports, and a custom PT staff survey.

Results:

Documentation of functional measurements tools improved from the baseline of 12% to 89.5% after full project interventions. Follow-up survey results indicated that PTs' perception of providing the highest quality of care increased by 29 percentage points, from 71% to 100%. Improved diversity of tool usage was also noted. Of the tools documented, Activity Measure for Post-Acute Care (AMPAC) functional measurement tool was selected 90% of the time at baseline and dropped to 66% post-intervention, allowing for a 24% increase in diversity of tool selection.

Conclusions:

Accurate discovery of the primary and secondary factors impacting tool use with targeted interventions yielded a 7.5-fold improvement (from 12% to 89.5%) in performance and documentation of functional measurement tools during PT evaluation and reevaluation sessions in the acute care setting. The project also highlighted limitations of education alone in effectively promoting adherence to best practice standards. The increased utilization and documentation of functional measurement tools has improved PT practice in this academic medical center through more objective detection of functional changes across the continuum. It should also promote targeted PT interventions, which should improve PT effectiveness and potentially even impact hospital length of stay.
Stroke-Specific Refinements to Naylor's Transitional Care Model to Address the Storm of Uncertainty and Unmet Survivor and Caregiver Needs
Authors: Laws Lorre , Ritter Leslie , Loescher Lois , McEwen Marylyn
Published: December 2021

BACKGROUND: By 2030, there will be approximately 7.6 million stroke survivors (SSs) in the United States, yet comprehensive transitional care (TC) for stroke is not widely available. Stroke strikes without warning and leaves in its wake a “storm” of uncertainty for SSs and caregivers (CGs) as they encounter a myriad of unmet physical, mental, emotional, and financial needs that are not wholly addressed by passive healthcare delivery systems. Needed is a stroke-specific TC model that bridges this storm to active delivery of SS and CG postacute care. Naylor's Transitional Care Model (NTCM) has not been examined for how it can frame comprehensive stroke care. The purpose of this study was to solicit SS and CG descriptions of TC experiences to inform the NTCM with refined operational definitions and exemplars specific to stroke. METHODS: Focus groups conducted for this qualitative descriptive study were guided by interview questions based on the 8 NTCM operational definitions. Data were analyzed using inductive and deductive qualitative content analysis methods. RESULTS: Post–acute-stroke care does not comprehensively meet the needs of SSs and CGs. Participants described TC deficits across all 8 NTCM components. Two new subcomponents that could be applied for a stroke-specific NTCM emerged: psychological and transportation challenges. CONCLUSION: Unmet needs identified by SSs and CGs were used to extend NTCM specific to the stroke population and to develop the Recommendations and Exemplars for Stroke Specific Comprehensive Transitional Care Delivery (see Supplementary Digital Content, available at http://links.lww.com/JNN/A385). Researchers and practitioners can use the findings to develop and deliver more comprehensive TC to SSs and CGs.
Drug-coated balloon versus drug-eluting stent in acute myocardial infarction
Authors: Geng Baoyu , Liu Zhe , Feng Guangzhi , Jiang Jun
Published: December 2021

Background:

Previous studies comparing the published literature on drug-eluting stents (DES) and drug-coated balloon (DCB) have drawn divergent conclusions, as these studies are limited by small sample sizes. To overcome these limitations, we thus conducted a high-quality systematic review and meta-analysis to assess the efficacy and safety of DCB versus DES for patients with acute myocardial infarction (AMI). It was hypothesized that DCB use at the AMI is associated with decreased risk of cardiovascular disease and death.

Methods:

The electronic databases Embase, Medline, PubMed, and Cinahl were searched from the earliest available date until August 2021. Study included in our study had to meet all of the following inclusion criteria: all randomized controlled trials to assess the efficacy and safety of DES versus DCB in the treatment of AMI were considered eligible for analysis; participants received DCB or DES; reporting the available data on cardiac death, all-cause death, myocardial infarction, target lesion revascularization, target vessel revascularization, major adverse cardiac events, and stent thrombosis. Review Manager Software (v 5.3; Cochrane Collaboration) was used for the meta-analysis. Two of us independently assessed the risk of bias in the included studies using parameters defined in the Cochrane Handbook for Systematic Reviews of Interventions criteria.

Results:

It was hypothesized that DCB use at the AMI is associated with decreased risk of cardiovascular disease and death.

Registration number:

10.17605/OSF.IO/AVTYW.
Visual analysis on the research of monocarboxylate transporters based on CiteSpace
Authors: Li Feifei , Wang Shuqi , Yao Youlong , Sun Xueming , Wang Xiaoyan , Wang Ning , You Yulin , Zhang Yanli
Published: December 2021

Background:

Monocarboxylate transports (MCTs), a family of solute carrier protein, play an important role in maintenance of cellular stability in tumor cells by mediating lactate exchange across membranes. The objective of this paper is to evaluate the knowledge structure, development trend, and research hotspot of MCTs research field systematically and comprehensively.

Methods:

Based on the 1526 publications from 2010 to 2020 retrieved from “Web of Science Core Collection” (WoSCC), we visually analyzed the MCTs research in terms of subject category, scientific collaboration network, keywords, and high-frequency literature using CiteSpace.

Results:

The number of publications exhibits an upward trend from 2010 to 2020 and the top 5 countries in the MCTs research were the United States, China, Japan, Germany, and England. Visser TJ was the most prolific author, while Halestrap AP was the most influential author with the highest citations. Analysis of the 7 cluster units from the co-cited references and keywords revealed that high expression of MCTs induced by oxidative stress and glycolysis was the pivotal point in the MCTs research field, while regulation of metabolism in tumor microenvironment, prognostic markers of cancer, and targeted inhibitors are the top 3 research frontiers topics.

Conclusion:

This study will help the new researcher to understand the MCTs related field, master the research frontier, and obtain valuable scientific information, thus providing directions for follow-up research.
Genome-wide association study identifies BTNL2 associated with atopic asthma in children
Authors: Kim Soo Yeon , Kim Eun Gyul , Kim Mina , Hong Jung Yeon , Kim Ga Eun , Jung Jae Hwa , Park Mireu , Kim Min Jung , Kim Yoon Hee , Sohn Myung Hyun , Kim Kyung Won
Published: December 2021

Asthma is a heterogeneous disease characterized by chronic airway inflammation with a genetic predisposition. Butyrophilin-like 2 (BTNL2) is a member of the immunoglobulin superfamily that plays an important role in regulating T cell activation and immune homeostasis. Here, we aimed to investigate the association of the genetic variants of BTNL2 with childhood asthma and asthma-related traits by utilizing extreme asthma phenotypes and employing a genome-wide association study. Our study included 243 children with well-defined moderate to severe atopic asthma and 134 healthy children with no history of allergic diseases and allergic sensitization. DNA from these subjects was genotyped using AxiomTM Genome-Wide Array Plates. Although no single nucleotide polymorphisms (SNPs) reached a genome-wide threshold of significance, 3 SNPs, rs3817971, rs41355746, and rs41441651, at BTNL2 were significantly associated with moderate to severe atopic asthma after performing Bonferroni correction. These SNPs were also associated with the risk of allergic sensitization toward house dust mites and the presence and degree of bronchial hyperresponsiveness. Thus, we identified that BTNL2 was associated with atopic moderate to severe persistent asthma in Korean children, and this may play an important role in disease development and susceptibility.
Risks for bicycle-related injuries in Al Ain city, United Arab Emirates
Authors: Grivna Michal , AlKatheeri Ahmed , AlAhbabi Mohammed , AlKaabi Saeed , Alyafei Mohammed , Abu-Zidan Fikri M.
Published: December 2021

Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.

We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.

Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.

Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.
Clinical predictive score for detecting nonalcoholic fatty liver disease with significant fibrosis in patients with metabolic syndrome
Authors: Kositamongkol Chayanis , Charernboon Thammanard , Chaisathaphol Thanet , Washirasaksiri Chaiwat , Auesomwang Chonticha , Sitasuwan Tullaya , Charatcharoenwitthaya Phunchai , Phisalprapa Pochamana
Published: December 2021

Patients with metabolic syndrome are at a higher risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis than the general population. Still, accessibility of screening method for NAFLD with significant fibrosis, such as transient elastography (FibroScan) are limited in some settings. This study aimed to develop a simple clinical predictive score for detecting NAFLD with significant fibrosis in patients with metabolic syndrome.

A cross-sectional study was designed to obtain the data from medical records of all relevant patients who underwent transient elastography between January 2011 and December 2020 at Siriraj Hospital, Thailand. A liver stiffness cutoff value of 7.0 kilopascal was used to define the presence of significant liver fibrosis. To examine potential predictors, medical history and clinical data commonly assessed in routine practice were selected by following expert opinions and univariable statistical analysis. Backward and forward stepwise logistic regression was performed to acquire a final prediction model. To simplify the model, a weighted score was assigned for each categorized predictor. In addition, eligible cutoff values of the score and their predictive performances were determined.

A total of 745 medical records were reviewed. The prevalence of NAFLD with significant fibrosis in patients with metabolic syndrome was 12.6%. Most clinical characteristics of patients with NAFLD with significant fibrosis and those non-NAFLD and NAFLD with no/mild fibrosis were quite disparate. The most practical model comprised globulin, aspartate transaminase, platelet count, and type 2 diabetes. It provided a good predictive performance with an area under the receiver operating characteristic curve of 0.828 (95% confidence interval [CI]: 0.782, 0.874). At the proper cutoff value, sensitivity and specificity were 76.6% (95% CI: 66.7%, 84.7%) and 72.4% (95% CI: 68.7%, 75.8%), respectively. The likelihood ratio of testing positive for NAFLD with significant fibrosis was 2.8 (95% CI: 2.34, 3.27) among patients with scores above the cutoff value.

The first score for detecting of NAFLD with significant fibrosis in patients with metabolic syndrome was developed. This practical score, providing a good predictive performance, should be useful to help clinicians prioritize needs for further investigations among high-risk patients, especially in resource-limited settings.
Evaluation of previous management against a developed clinical pathway for chronic rhinosinusitis with nasal polyposis in Universiti Kebangsaan Malaysia Medical Center
Authors: Wong Timothy LW , Husain Salina , Ismail Aniza , Zahedi Farah Dayana , Aljunid Syed Mohamed , Nur Amrizal Muhammad
Published: December 2021

The study aims to evaluate previous management of CRSwNP patients in Universiti Kebangsaan Malaysia Medical Center (UKMMC) against a developed CP.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) has high economic burden and impacts patient's quality of life. Implementation of clinical pathway (CP) can standardize care while optimizing resources.

Analytical cross-sectional

This study utilized medical records of 103 CRSwNP patients at UKMMC otorhinolaryngology clinic from 2010 to 2015. Patients were divided into groups who underwent or did not undergo surgery. Information was obtained regarding sociodemographic, follow-ups, pharmaceutical regimes, and treatment cost. Cost analysis was done using top-down analysis and activity-based costing and CP was formulated. Cost was calculated using year 2020 rates to adjust for inflation. (United States Dollars [USD]1 = Ringgit Malaysia [RM] 4.2015)

Study showed non-CP patients were undertreated compared to CP. This affects clinical outcomes as optimal treatment demanded by CP was not achieved. Total cost for non-CP, non-surgery patients were lower (USD660) compared to CP (USD780) due to under treatment and shorter follow-ups. Meanwhile, total cost for non-CP surgery patients were higher (USD3600) compared to CP (USD2706) due to longer visit durations and hospital stays. Non-CP surgery group underwent lengthy follow-up duration (20.7 months) prior to operation compared to 12 months expected in CP.

Study showed non-CP patients were undertreated compared to CP. We identified aspects which resulted in resource wastage and unnecessary burden to our healthcare system. This study enables development of a written CP by fine-tuning various aspects of CP which could be applied to our future practice.
The efficacy of Chinese herbal medicine Buyang Huanwu Decoction combined with acupuncture to treat sequela of apoplexy
Authors: Zhang Jiayu , Li Zhaowei , Zhang Liang
Published: December 2021

Background:

Stroke is a common disease in neurology, patients often have different degrees of sequelae, which affect the patient's quality of life. We conducted a protocol for systematic review and meta-analysis to assess the efficacy of Buyang Huanwu Decoction combined with acupuncture for the treatment of stroke sequelae.

Methods:

The current protocol is prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols statement guideline. Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, and Cochrane Library were searched in August 2021 by 2 independent reviewers. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We will perform meta-analysis using STATA 11.0 (http://www.stata.com; Stata Corporation, College Station, TX).

Results:

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Conclusion:

Buyang Huanwu Decoction combined with acupuncture seems to be an effective therapy to ameliorate the clinical symptoms of stroke sequelae. In order to further determine the effectiveness and safety of Buyang Huanwu Decoction combined with acupuncture in treating stroke sequelae, more multicenter and prospective randomized controlled trials must be carried out.
Efficacy of acupuncture combined with Chinese herbal medicine for the treatment of chronic nephritis
Authors: Zheng Xue , Zhang Shoulin , Wang Zhilei , Zou Di
Published: December 2021

Background:

Chronic nephritis is a common kidney disease that afflicts people worldwide. The disease has main manifestations of proteinuria, hematuria, edema, and hypertension that are associated with kidney-damaging processes that eventually lead to kidney failure. Traditional Chinese medicine involving combination treatment with herbal remedies and acupuncture has been shown clinically to alleviate chronic nephritis, although to date no systematic review of the efficacy of this combination treatment for this purpose has been reported, prompting this study. Here we conducted a systematic review and meta-analysis of published randomized clinical trials to scientific evidence and credible medical references supporting the clinical efficacy of this combination treatment when used to treat chronic nephritis.

Methods:

We will search the following 8 electronic Chinese and English databases: Web of Science, PubMed, Cochrane Library, Embase, China Biomedical Literature Database, China National Knowledge Infrastructure, China Scientific Journal Database, and the Wanfang database. All electronic databases will be searched from inception to October 10, 2021. All statistical analyses will be performed using Review Manager Version 5.4 provided by the Cochrane Collaboration Network.

Results:

The protocol for systematic review and meta-analysis will be applied to evaluate the efficacy of acupuncture combined with Chinese herbal medicine for the treatment of chronic nephritis.

Conclusion:

We plan to submit the results of this research to a peer-reviewed journal.

INPLASY registration number:

INPLASY2021100051.
The effects of traditional Chinese manual therapy (Tuina) for chronic fatigue syndrome
Authors: Ren Jun , He Tianxiang , Zhou Xin , Wu Zhiwei , Kong Lingjun
Published: December 2021

Background:

Chronic fatigue syndrome (CFS) is a common disease and characterized by fatigue, exhaustion, heavy limbs, and dizziness. Tuina, as a traditional Chinese manual therapy, is usually used for CFS in China. Several studies have reported that Tuina can improve fatigue exhaustion, and dizziness of patients with CFS. However, the effects of Tuina for CFS still remain controversial. Therefore, the current systematic review and meta-analysis will be conducted to investigate the effects of Tuina in the management of CFS.

Methods:

The comprehensive electronic search of PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang Database, Embase, Cochrane Library, Chinese Science Citation Database, Technology Periodical Database from their inception to October 2021 will be conducted. Randomized controlled trials of Tuina for CFS will be included in the review. Two independent reviewers will complete the study selection, data extraction, and the risk of bias. The meta-analysis will be conducted using the Review Manager Version 5.3 software. The heterogeneity will be assessed using the I

2
statistic and Q statistic. The standardized mean difference and 95% confidence intervals will be calculated based on different heterogeneity. The subgroup analysis will be conducted based on the duration of treatment, age, gender, duration of CFS. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

Results:

The current systematic review and meta-analysis will be to investigate the effects of Tuina in the management of CFS.

Conclusion:

The conclusion of this study will provide the evidence for the treatment of CFS in the future. It is expected that the conclusions drawn from this review will benefit patients, clinical practitioners and policy makers.
Effects of cupping therapy for obesity
Authors: Kim Hyungsuk , Kim Koh-Woon , Chung Won-Seok
Published: December 2021

Background:

Obesity is a prevalent disease in modern society. Despite the various interventions available in conventional medicine, their success rates are not satisfactory because of the complex mechanisms involved in obesity. Cupping therapy is a traditional Chinese medicinal intervention, and it has become widely used in various clinical settings for the treatment of obesity. This systematic review and meta-analysis will investigate the effects of cupping on obesity.

Methods:

Three Korean databases (KoreaMed, Oriental Medicine Advanced Searching Integrated System, and ScienceON), 1 Japanese database (Citation Information by the National Institute of Informatics), 1 Chinese database (Chinese National Knowledge Infrastructure), MEDLINE/PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials will be searched for studies published until March 2021. The primary outcome is body weight. The secondary outcomes will be body mass index, waist-hip ratio, waist circumference, hip circumference, body fat mass, body fat percentage, and adverse events.

Results:

This systematic review and meta-analysis will evaluate the effects of cupping therapy for obesity.

Conclusion:

The results of this systematic review and meta-analysis will then be discussed in a related journal for clinicians working with obese patients to apply the interventions in this article.

Trial registration number:

DOI 10.17605/OSF.IO/P8JVM (https://osf.io/p8jvm).
Prediction of a 10-year risk of type 2 diabetes mellitus in the Turkish population
Authors: Sezer Önder , Özdoğan Lafçi Neslihan , Korkmaz Selçuk , Dağdeviren Hamdi Nezih
Published: December 2021

According to the International Diabetes Federation, Turkey will be among the top 10 countries in the world with the highest prevalence of diabetes mellitus (DM) by 2045, with a speculated number of cases of 10.4 million.

This study aimed to predict the 10-year risk of type 2 DM in a Turkish population, assess potential factors of the 10-year risk of DM, and assess the outcomes of Turkey's 2015 to 2020 program for DM.

Individuals aged 20–64 years were categorized and stratified according to age (in ranges of 5 years), sex, and populations of family medicine centers to reflect the whole population. The Finnish Diabetes Risk Score, sociodemographic characteristics, body fat, muscle, bone ratio, blood pressure, and waist-to-height ratio were evaluated.

We found that 9.5% (n = 71) of the population aged 20 to 64 years will have DM within the next 10 years. Low levels of education (odds ratio [OR]: 2.054; 95% confidence interval [CI]: 1.011–4.174), smoking cessation (OR: 2.636; 95% CI: 1.260–5.513), a waist-to-height ratio >0.5 (OR: 6.885; 95% CI: 2.301–20.602), body fat percentage (OR: 1.187; 95% CI: 1.130–1.247), high systolic blood pressure (OR: 1.025; 95% CI: 1.009–1.041), and alcohol consumption (beta-estimation: −0.690; OR: 0.501; 95% CI: 0.275–0.914) affect the 10-year risk of type 2 DM.

Individuals at risk for DM can be easily identified using risk assessment tools in primary care; however, there is no active screening program in the healthcare system, and only proposals exist. In addition to screening, preventive measures should focus on raising awareness of DM, reducing body fat percentage and systolic blood pressure, and decreasing the waist-to-height ratio to <0.5.
Urorectal septum malformation sequence with a giant calculus in the colon cyst in an adult
Authors: Zeng Xue , Xiao Bo , Su Bo-Xing , Yao Jing-Jing , Ji Chao-Yue , Li Jian-Xing
Published: December 2021

Introduction:

The present article reports urinary and digestive system abnormalities, including retrocaval ureter, anal atresia, and colon duct cyst with duplicate urethra carrying a giant calculus in a 40-year-old man.

Patient concerns:

A 40-year-old man visited the hospital complaining of acute pain in the right lower abdomen.

Diagnosis:

Cystoscopy showed that the patient had duplicated urethra and bladder, and pathology showed that the duplicated bladder consisted of colon tissue, which led to the diagnosis of a urorectal septum malformation sequence.

Interventions and outcomes:

The calculus was removed, and the retrocaval ureter was treated with laparoscopic ureteroureterostomy. We followed up for 3 months after the secondary surgery, and there were no complications.

Conclusion:

A urorectal septum malformation sequence with a giant calculus in a colon cyst is rare. Hence, clinicians should be aware of the possibility of calculus formation in patients with a urorectal septum malformation sequence.
Recessive RYR1-related centronuclear myopathy with congenital chylothorax in a Japanese male child
Authors: Tanaka Yuichiro , Fukuhara Yasuyuki , Maiberger Thomas , Kubota Masaya , Ishiguro Akira , Kubota Mitsuru
Published: December 2021

Introduction:

The severity of RYR1-related centronuclear myopathy (CNM) is typically intermediate between the most severe X-linked myotubular myopathy and mildly severe DNM2-related centronuclear myopathy. We report a Japanese male patient with recessive RYR1-related CNM that was exceedingly severe compared to previously reported cases and had congenital chylothorax, which is a very rare complication of congenital myopathy.

Patient concerns:

A male neonate from non-consanguineous Japanese parents presented with generalized hypotonia and respiratory distress at birth.

Diagnosis:

Muscle biopsy of the vastus lateralis showed typical features of CNM. The next-generation sequencing assay detected RYR1 gene mutations, which were c.5989G>A (p.E1997K) and c.1441-2A>G. These findings confirmed the diagnosis of recessive RYR1-related CNM. Chest radiography showed bilateral pleural effusions at birth, which was diagnosed as chylothorax on laboratory examination.

Interventions:

Mechanical ventilation and tube feeding were initiated. Chylothorax was managed with drainage and treatment with octreotide acetate.

Outcomes:

His clinical course was so rapidly progressive that he could not move his fingers even when he was one year of age.

Conclusion:

Congenital chylothorax with congenital myopathy can be considered an indicator of a severe phenotype, and its presence may indicate poor prognosis.
Superior mesenteric vein thrombosis in a patient with primary focal segmental glomerulosclerosis
Authors: Somaili Mohammed , Wang Carol , Almansour Omar , Alrefa’ei Basma
Published: December 2021

Introduction:

Nephrotic syndrome creates a hypercoagulable state that predisposes patients to venous thromboembolism. Mesenteric vein thrombosis associated with minimal change disease and membranous nephropathy has rarely been reported. Few cases of mesenteric vein thrombosis have been reported in some types of nephrotic syndrome; however, isolated mesenteric vein thrombosis has not been previously reported in adults with nephrotic syndrome due to focal segmental glomerulosclerosis.

Patient concern:

A 19-year-old man with biopsy-proven primary focal segmental glomerulosclerosis was in partial disease remission when he presented with postprandial abdominal pain four months after starting prednisone therapy.

Diagnosis:

Abdominal computed tomography revealed subacute superior mesenteric vein thrombosis complicated by distal ileum ischemia.

Intervention:

The patient was treated with low-molecular-weight heparin and bridged with warfarin. Prednisone therapy was continued for the underlying nephrotic syndrome.

Outcomes:

The patient's symptoms improved with conservative management. He continued to be asymptomatic at subsequent follow-up visits, with no reported complications or medication side effects.

Conclusion:

This unique case of superior mesenteric vein thrombosis in an adult with nephrotic syndrome due to primary focal segmental glomerulosclerosis in partial remission diagnosed on computed tomography was treated conservatively with anticoagulation therapy. The findings in this case suggest that in patients with nephrotic syndrome, hypercoagulability may extend beyond the acute stage of the disease despite treatment.
Colorectal cancer screening by fecal immunochemical test or colonoscopy in France: how many people are actually covered? Focus on the Provence-Alpes-Côte d’Azur region
Authors: Seitz Jean-François , Lapalus David , Arlotto Sylvie , Gentile Stéphanie , Ettori Florence , Rinaldi Yves , Grandval Philippe , Delasalle Patrick
Published: December 2021

Background

Colorectal cancer (CRC) screening with fecal immunochemical test (FIT) remains low in France, particularly in the Provence-Alpes-Côte-d’Azur (PACA) region. The aim of this study was to compare insured persons (50–74 years) who had FIT and/or colonoscopy in PACA with the general French population.

Methods

FIT and colonoscopy rates were calculated according to SP-France and National Health Data System data.

Results

The rate of FIT in 2016–2017 was lower in PACA than in France (25.6 vs. 29.1%, P < 0.001). Conversely, in 2013–2017, the rate of colonoscopy in the past 5 years was higher in PACA than in France (23.1 vs. 20.1%, P < 0.001). Total rate for FIT within 2 years and/or colonoscopy within 5 years was 46.0% in PACA vs. 46.5% in France (P < 0.001). Overuse was higher for diagnostic (1.21) than therapeutic colonoscopies (1.05). Therapeutic colonoscopy occurred more with FIT than without (47.88 vs. 38.7%, P < 0.001). According to USA criteria, persons with FIT within 2 years and/or sigmoidoscopy and/or colonoscopy within 10 years was 59.4% in PACA vs. 54.7% in France (P < 0.001).

Conclusion

Low participation in FIT in France must be improved to increase the rate of therapeutic colonoscopies and reduce the incidence of CRC. The higher colonoscopy rate in PACA could explain the lower CRC mortality. Efforts should be focused on the more than 40% of French insured who are not screened by either FIT or colonoscopy.
The Impact of Lockout Laws on Maxillofacial Fractures in South Australia
Authors: Diab Jason , Moore Mark H.
Published: December 2021

Introduction:

Alcohol outlet density and unrestricted trading hours are strongly predictive of domestic and non-domestic assault rates, respectively. international studies report a strong male predominance for facial fractures. Harm minimization policies such as lockout laws have gained considerable attention to reduce accessibility of alcohol consumption and drinking patterns.

Methods:

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to determine the impact of facial fracture presentations, particularly assaults, for the pre- and post-lockout periods.

Results:

From 2012 to 2017, there was a 5.1% decrease in assaults per year (P = 0.002). Assaults increased by 11.7% for women and alcohol related assaults decreased by 10.2% for men (P < 0.05). Assault and alcohol related assault rates decreased by 9.3% and 10.5%, respectively, between lockout periods (P < 0.001). Comparative analysis between Adelaide and control (inner regional city) showed assaults decreased by 9.8% between lockout periods (51.2% versus 41.4%, P < 0.001). Multivariate analysis showed alcohol, open reduction internal fixation and men were associated with a lower risk of assault related fractures, but women and night time presentations had a higher risk (P < 0.05).

Conclusions:

The influence of lockout laws contributed to an overall decrease in assaults and operative interventions, particularly alcohol related incidences amongst men. Ongoing longitudinal surveillance should guide current evidence for policy developers to reduce the risk of harm.
Multimodal analgesia reduces opioid requirements in trauma patients with rib fractures
Authors: Burton Shakira W. , Riojas Christina , Gesin Gail , Smith Charlotte B. , Bandy Vashti , Sing Ronald , Roomian Tamar , Wally Meghan K. , Lauer Cynthia W.
Published: December 2021

BACKGROUND

Rib fractures are common in trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is essential to avoid the complications associated with rib fractures. Opioids are frequently used for analgesia in these patients. This study compared the effect of a multimodal pain regimen (MMPR) on inpatient opioid use and outpatient opioid prescribing practices in adult trauma patients with rib fractures.

STUDY DESIGN

A pre-post cohort study of adult trauma patients with rib fractures was conducted at a Level I trauma center before (PRE) and after (POST) implementation of an MMPR. Patients on long-acting opioids before admission and those on continuous opioid infusions were excluded. Primary outcomes were oral opioid administration during the first 5 days of hospitalization and opioids prescribed at discharge. Opioid data were converted to morphine milligram equivalents (MMEs).

RESULTS

Six hundred fifty-three patients met inclusion criteria (323 PRE, 330 POST). There was a significant reduction in the daily MME during the second through fifth days of hospitalization; and the average inpatient MME over the first five inpatient days (23 MME PRE vs. 17 MME POST, p = 0.0087). There was a significant reduction in the total outpatient MME prescribed upon discharge (322 MME PRE vs. 225 MME POST, p = 0.006).

CONCLUSION

The implementation of an MMPR in patients with rib fractures resulted in significant reduction in inpatient opioid consumption and was associated with a reduction in the quantity of opiates prescribed at discharge.

LEVEL OF EVIDENCE

Therapeutic/Care Management; level IV.
Mesenchymal stem cell extracellular vesicles mitigate vascular permeability and injury in the small intestine and lung in a mouse model of hemorrhagic shock and trauma
Authors: Barry Mark , Trivedi Alpa , Pathipati Praneeti , Miyazawa Byron Y. , Vivona Lindsay R. , Togarrati Padma Priya , Khakoo Manisha , Tanner Heather , Norris Philip , Pati Shibani
Published: December 2021

BACKGROUND

Hemorrhagic shock and trauma (HS/T)-induced gut injury may play a critical role in the development of multi-organ failure. Novel therapies that target gut injury and vascular permeability early after HS/T could have substantial impacts on trauma patients. In this study, we investigate the therapeutic potential of human mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (MSC EVs) in vivo in HS/T in mice and in vitro in Caco-2 human intestinal epithelial cells.

METHODS

In vivo, using a mouse model of HS/T, vascular permeability to a 10-kDa dextran dye and histopathologic injury in the small intestine and lungs were measured among mice. Groups were (1) sham, (2) HS/T + lactated Ringer's (LR), (3) HS/T + MSCs, and (4) HS/T + MSC EVs. In vitro, Caco-2 cell monolayer integrity was evaluated by an epithelial cell impedance assay. Caco-2 cells were pretreated with control media, MSC conditioned media (CM), or MSC EVs, then challenged with hydrogen peroxide (H2O2).

RESULTS

In vivo, both MSCs and MSC EVs significantly reduced vascular permeability in the small intestine (fluorescence units: sham, 456 ± 88; LR, 1067 ± 295; MSC, 765 ± 258; MSC EV, 715 ± 200) and lung (sham, 297 ± 155; LR, 791 ± 331; MSC, 331 ± 172; MSC EV, 303 ± 88). Histopathologic injury in the small intestine and lung was also attenuated by MSCs and MSC EVs. In vitro, MSC CM but not MSC EVs attenuated the increased permeability among Caco-2 cell monolayers challenged with H2O2.

CONCLUSION

Mesenchymal stem cell EVs recapitulate the effects of MSCs in reducing vascular permeability and injury in the small intestine and lungs in vivo, suggesting MSC EVs may be a potential cell-free therapy targeting multi-organ dysfunction in HS/T. This is the first study to demonstrate that MSC EVs improve both gut and lung injury in an animal model of HS/T.
Mitochondria play a key role in oxidative stress-induced pancreatic islet dysfunction after severe burns
Authors: Liu Xinzhu , Liu Zhaoxing , Li Dawei , Niu Yuezeng , Zhang Wen , Sun Jiachen , Zhang Kun , Zhao Hongqing , Li Zhisheng , Shen Chuan'an
Published: December 2021

BACKGROUND

Severe burns are often complicated with hyperglycemia in part caused by pancreatic islet dysfunction. Previous studies have revealed that in diabetes mellitus, the pancreatic islet dysfunction is partly attributed to oxidative stress. However, the role and mechanism of oxidative stress in hyperglycemia after severe burns remain unclear. Therefore, the purpose of this study was to explore the level and mechanism of oxidative stress in pancreatic islets after severe burns and the antioxidant effect of sodium pyruvate.

METHODS

A 30% total body surface area full-thickness burn model was established using male C57BL/6 mice. Fasting blood glucose and glucose-stimulated insulin secretion (GSIS) 24 hours post severe burns were detected. The levels of reactive oxygen species (ROS) and mitochondrial ROS of islets were detected. The activities of complexes in the mitochondrial respiratory chain of islets were measured. The main antioxidant defense system, glutaredoxin system, and thioredoxin system-related indexes were detected, and the expression of manganese superoxide dismutase (Mn-SOD) was measured. In addition, the antioxidant activity of sodium pyruvate was evaluated post severe burns.

RESULTS

After severe burns, fasting blood glucose levels increased, while GSIS levels decreased, with significantly elevated ROS levels of pancreatic islets. The activity of complex III decreased and the level of mitochondrial ROS increased significantly post severe burns. For the detoxification of ROS, the expressions of thioredoxin 2, thioredoxin reductase 2, and Mn-SOD located in mitochondria decreased. Sodium pyruvate reduced the level of mitochondrial ROS in islet cells and improved the GSIS of islets after severe burns.

CONCLUSION

The high level of mitochondrial ROS of islets is caused by reducing the activity of complex III in mitochondrial respiratory chain, inhibiting mitochondrial thioredoxin system, and downregulating Mn-SOD post severe burns. Sodium pyruvate plays an antioxidant role post severe burns in mice islets and improves the islet function.
Penile implant infection resulting in Staphylococcus aureus bacteraemia and infective endocarditis
Authors: Creel Joseph P. , Triplett David , Nayyar Mannu , Summers Nathan A.
Published: December 2021

Introduction. Penile implant infections are a possible surgical complication that has historically been most commonly associated with Gram-positive bacteria.

Staphylococcus aureus

is a Gram-positive bacteria and is the most common cause of endocarditis.

Case Presentation. A male patient in his 50s with a past medical history of hypertension, diabetes, end-stage renal disease (ESRD) on peritoneal dialysis (PD) and erectile dysfunction with a penile implant placed 6 years prior to the admission date presented with complaints of scrotal pain. The pump for his implant had eroded through his scrotum and was draining pus. Blood cultures returned positive for Gram-positive cocci in clusters in 4/4 bottles, which was eventually identified as methicillin-sensitive

Staphylococcus aureus

(MSSA). A transthoracic echocardiogram (TTE) was performed due to concern for infective endocarditis (IE) but did not show any valvular abnormalities. Due to high clinical suspicion, a transesophageal echocardiogram (TEE) was performed and revealed a vegetation on the native mitral valve. His penile implant was removed by urology and intraoperative cultures grew MSSA. Surgical valve replacement was not recommended, and the patient was sent home with IV antibiotics for 6 weeks.

Discussion. Post-operative site infections are a quite uncommon point of entry for infective endocarditis, with penile implant infections being an even rarer cause. While a TTE is often used initially to attempt to diagnose infective endocarditis, it has lower sensitivity than a TEE. If clinical suspicion for infective endocarditis remains high after negative imaging with TTE, then TEE should be performed for better visualization of the heart valves.
The methylation-independent mismatch repair machinery in Pseudomonas aeruginosa
Authors: On Yue Yuan , Welch Martin
Published: December 2021

Over the last 70 years, we’ve all gotten used to an

Escherichia coli

-centric view of the microbial world. However, genomics, as well as the development of improved tools for genetic manipulation in other species, is showing us that other bugs do things differently, and that we cannot simply extrapolate from

E. coli

to everything else. A particularly good example of this is encountered when considering the mechanism(s) involved in DNA mismatch repair by the opportunistic human pathogen,

Pseudomonas aeruginosa

(PA). This is a particularly relevant phenotype to examine in PA, since defects in the mismatch repair (MMR) machinery often give rise to the property of hypermutability. This, in turn, is linked with the vertical acquisition of important pathoadaptive traits in the organism, such as antimicrobial resistance. But it turns out that PA lacks some key genes associated with MMR in

E. coli

, and a closer inspection of what is known (or can be inferred) about the MMR enzymology reveals profound differences compared with other, well-characterized organisms. Here, we review these differences and comment on their biological implications.