bluuebunny/crossref_metadata_2025 huggingface dataset:
Target Selection for Parkinson Disease With Medication-Refractory Unilateral Resting Tremor
Authors: Sasaki Fuyuko , Shimo Yasushi , Hattori Nobutaka
Published: June 2020

A 67-year-old, right-handed man had a 7-year history of right-dominant, severe medication-refractory resting and action-postural tremor, rigidity, bradykinesia, and impairment of postural reflexes, with his symptoms poorly responsive to oral antiparkinsonian medication. His parkinsonian symptoms with the exception of tremor responded to levodopa infusion. His most bothersome symptom was tremor, and implantation of a left subthalamic nucleus (STN) deep brain stimulation (DBS) lead was pursued with possible posterior subthalamic area (PSA) DBS if the tremor suppression by STN was not intraoperatively sufficient. Ultimately, the STN DBS lead provided reasonable tremor suppression during the operation, and there was no need for PSA DBS. After the surgery, his tremor and other parkinsonian symptoms were well-controlled. This case highlights that unilateral STN DBS is a reasonable indication for medication-refractory parkinsonian tremor with significant laterality of bothersome symptoms, although other options may also be considered.
Use of Subthalamic Nucleus and Globus Pallidus Interna Deep Brain Stimulation Targets in the Same Patient With Parkinson’s Disease
Authors: Merchant Shabbir Hussain I. , Vanegas-Arroyave Nora
Published: June 2020

Deep brain stimulation (DBS) is an excellent therapy for the treatment of levodopa-refractory tremor and motor fluctuations in Parkinson disease (PD). Asymmetry is an inherent clinical characteristic of PD, noted in terms of clinical severity, but can also be noted in terms of the clinical characteristics of PD motor symptoms. This chapter presents a case of a patient with relatively early onset of PD, whose phenotype was characterized by predominant medication-refractory tremor on one side and hemidystonia on the contralateral side. He was successfully treated using DBS, with a combination of subthalamic nucleus (contralateral to the tremor predominant side) and globus pallidus interna (contralateral to the dystonia predominant side) targets to facilitate medication reduction, tremor resolution, and treatment of dystonia and dystonic dyskinesias. The case highlights the importance of using a nuanced approach in DBS target selection in PD, based on the phenomenologic characteristics and consideration of postoperative programming challenges for optimal treatment outcomes.
Subthalamic Nucleus Deep Brain Stimulation May Improve Pain in the Setting of Parkinson Disease
Authors: Gera Anjali , Pal Gian
Published: June 2020

More than 50% of patients with Parkinson disease (PD) can have chronic pain. PD pain has been associated with reduced quality of life scores on validated measures. The most common source of PD pain is musculoskeletal in origin. This pain may manifest as rigidity, cramps, shoulder discomfort, spinal or hand and foot deformities, dystonic pain, or nonradicular back pain. Our case illustrates improvement in chronic pain following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in a 45-year-old patient with PD. Approximately 1 year after PD onset, he developed constant pain and tremor in his left upper extremity, which gradually worsened over time. Initially, carbidopa/levodopa completely alleviated both his arm tremor and pain. Over the next several years, he developed off periods that were associated with bothersome tremor and pain, and on periods that were associated with prominent neck and left arm dyskinesia, both of which were associated with significant pain. At age 60 years, after 15 years of PD, he underwent bilateral STN DBS implantation. Following DBS, he had significant improvement in his left arm tremor, rigidity, motor fluctuations, and pain. He also had a 70% reduction in his dopaminergic medication and complete resolution of dyskinesia and neck pain.
The Positive Lesion Effects of Intracranial Hemorrhage on Deep Brain Stimulation Surgery Outcome
Authors: Meystedt Jacqueline , Hacker Mallory , Charles David
Published: June 2020

This chapter reviews the case of a patient with Parkinson disease (PD) who experienced a sustained reduction in symptoms following perioperative intracranial hemorrhage (ICH). The patient, a 55-year-old man, elected to receive deep brain stimulation (DBS) after presenting with PD with rest tremor, bradykinesia, and rigidity. During the implantation operation, the patient suffered a small ICH in the left subthalamic nucleus (STN). Subsequently, he reported a significant improvement in right-side symptoms with the DBS device still in the off state. The case is discussed in detail in this chapter and briefly compared with similar cases that have previously been reported. Computed tomography and magnetic resonance imaging studies done shortly after the ICH occurred are also included.
Open Circuits and Loss of Deep Brain Stimulation Benefit in the Setting of Parkinson Disease
Authors: Tarakad Arjun , Jimenez-Shahed Joohi
Published: June 2020

This case details a patient with PD who underwent bilateral STN DBS for refractory tremor who initially responded well to surgery with a bipolar programming configuration. Seven years after the initial surgery, the patient developed recurrent tremor symptoms and was found to have an open circuit at an active contact. Attempting to use similar settings at an adjacent contact did not sufficiently recapture benefit. While revision surgery was being considered, thorough re-evaluation of functioning contacts demonstrated benefit of tremor control when switching back to a monopolar configuration. The patient has had sustained benefit since that time (~2 years) without requiring a hardware revision. The case demonstrates that in the event of a stable hardware abnormality such as an open circuit, careful reprogramming can be used in select cases in an effort to provide sustained clinical benefit without the need for invasive or costly revision surgery.
Patient Selection Criteria for Deep Brain Stimulation for Dystonia
Authors: Dahdah Laura S. Surillo , El-Nazer Rasheda , Dewey Richard B. , O’Suilleabhain Padraig , Chitnis Shilpa
Published: June 2020

Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned and twisting and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. A recent revision now classifies dystonia into two axes: (1) clinical characteristics (age at onset, temporal pattern, body distribution, whether focal, segmental, or generalized; and associated features) and (2) etiology, whether idiopathic/genetic or secondary to other neurological/medical diseases.
Pharmacological treatments for dystonia remain generally unsatisfactory and consist of various combinations of levodopa, anticholinergics, muscle-relaxing drugs as well as botulinum toxin injections in focal and segmental dystonia. Overall in outcomes are poor because of limited efficacy and the potential for significant side effects such as sedation and cognitive impairment.
A humanitarian-device exemption from the Food and Drug Administration was issued for the treatment of medically refractory symptoms of generalized dystonia with the use of DBS. Bilateral GPi DBS surgery is effective for both generalized and focal dystonia including cervical dystonia and tardive dystonia. DBS may be the best available treatment for disabling symptoms of generalized, cervical, tardive, and other dystonia that have failed to respond to oral drugs and botulinum toxin injections (when applicable) as long as contractures have not developed, because in this situation, DBS will be ineffective. Rigorous patient selection and careful management of comorbidities are essential for favorable outcomes.
Deep Brain Stimulation for Disabling “Outflow” Tremors
Authors: Shpiner Danielle S. , Bette Sagari , Luca Corneliu C.
Published: June 2020

“Outflow” tremors, sometimes referred to in the literature by a variety of terms (outflow, rubral, midbrain, Holmes), are frequently associated with significant disability and are notoriously unresponsive or only partially responsive to medical treatment. Deep brain stimulation (DBS) has been successfully used in patients with outflow tremors; however, long-term outcomes are not well-documented because large case series are hard to assemble. This chapter describes a patient with disabling outflow tremors secondary to multiple sclerosis, treated with unilateral thalamic DBS, who achieved excellent tremor control with initial programming but shortly afterward developed rebound tremor. Intensive programming involved alternating the site of stimulation by using different combinations of contacts; this was a successful strategy for maintaining a clinically significant reduction in tremor. Disease progression, worsening of tremor, habituation, and loss of efficacy are known problems with some tremors, and their management can be challenging. The pathophysiology of worsening tremor after DBS is discussed in the chapter, as are potential programming strategies to manage this problem.
Improved Cerebral Arteriovenous Malformation Obliteration With 3-Dimensional Rotational Digital Subtraction Angiography for Radiosurgical Planning: A Retrospective Cohort Study
Authors: Anderson Joshua L , Khattab Mohamed H , Sherry Alexander D , Luo Guozhen , Chitale Rohan V , Froehler Michael T , Fusco Matthew R , Cmelak Anthony J , Attia Albert
Published: June 2020

BACKGROUND

Stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVMs) is well-established. Radiographic advantages exist for 3-dimensional rotational digital subtraction angiography (3DRA) over 2-dimensional digital subtraction angiography (2D DSA) in delineating AVM nidus structure for SRS treatment planning. However, currently there is limited to no data directly comparing 2D DSA versus 3DRA in terms of patient outcomes.

OBJECTIVE

To investigate whether the use of 3DRA over 2D DSA in radiosurgical treatment planning for AVMs associates with improved clinical outcomes.

METHODS

All AVM patients treated with SRS at our institution between the years 2000 and 2018 were identified. Primary outcomes were obliteration rates and time to obliteration (TTO); secondary outcomes included rates of post-SRS hemorrhage, salvage therapy, and symptomatic radionecrosis. A minimum of 12 mo of follow-up imaging/angiogram post-SRS was required, or alternatively evidence of obliteration on angiogram prior to 12 mo post-SRS. Single predictor and multivariable Cox regression and logistic regression models were constructed to test for association between radiographic, clinical, and treatment factors with outcomes.

RESULTS

A total of 75 patients were included. Total 17 patients received 3DRA and 58 patients received 2D DSA, with a median follow-up of 3.29 yr. The 3DRA is significantly associated with improved TTO on single predictor (HR 2.87, 1.29-6.12; P = .0109) and multivariable analysis (HR 2.448, 1.076-5.750; P = .0330) and increased odds of achieving obliteration by 3 yr post-SRS on single predictor analysis (OR 6.044, 1.405-26.009; P = .0157).

CONCLUSION

The 3DRA over 2D DSA in SRS treatment planning for AVMs may result in improved TTO and 3-yr obliteration rates. Further investigation and prospective study are warranted.
On Squares of Sums of Three Cubes
Authors: Pliego Javier
Published: June 2020

We show that almost every positive integer can be expressed as a sum of four squares of integers represented as the sums of three positive cubes.
Political Identity and Confidence in Science and Religion in the United States
Authors: O’Brien Timothy L , Noy Shiri
Published: June 2020

This article investigates changes in public perceptions of science and religion in the United States between 1973 and 2018. We argue that the deepening ties between science and religion and opposing moral claims reconfigured the relationship between political identities and confidence in science and religion during this period. Our analysis of 30 waves of General Social Survey data finds that while Republicans once were more likely than Democrats to be more confident in science than religion, Democrats are now more likely to than Republicans. And, while Democrats used to be more likely than Republicans to be more confident in religion than science, this difference also reversed. These findings underscore the growing importance of political identities as predictors of confidence in science and religion and suggest that the politicization of science and religion fueled a perception that they provide not just alternative frameworks but opposing ones.
Words as well as Deeds: The Popular Press and Suffragette Hunger Strikes in Edwardian Britain
Authors: Vessey David
Published: June 2020

This article considers how national newspapers reported, portrayed, and narrated the militant suffragism of the Women’s Social and Political Union (WSPU). Using three popular newspapers, the Daily Mail, the Daily Express, and the Daily Mirror and the specific case study of hunger strikes and the government’s response of forcible feeding, it evaluates the various tropes that characterized press coverage of the suffragettes. It investigates how militancy, an approach that prioritized spectacle, was covered in an emerging medium that sought to recast politics in a new and spectacular fashion, thereby extending understanding of how the style and content of popular newspapers evolved in the first decade of the twentieth century. In doing so, it expands existing research into the dynamics of the nascent popular press and its function as an ‘arena’ for fostering extra-parliamentary political debate. The WSPU attempted to take advantage of this opportunity to promote its own arguments on forcible feeding and female suffrage, using correspondence columns and prisoner testimony to elicit empathy, albeit with only sporadic success in receiving a sympathetic hearing from a hostile press, with enmity a consistent feature of editorial argument. Nevertheless, the article concludes that responses to hunger strikes and forcible feeding in the popular press were multifaceted, and whilst the WSPU was unable to reframe patriarchal narratives of political activism, it persisted with words as well as deeds in seeking to co-opt newspapers into its campaign and garner publicity for its cause.
A Viable New Strategy for the Discovery of Peptide Proteolytic Cleavage Products in Plant-Microbe Interactions
Authors: Villalobos Solis Manuel I. , Poudel Suresh , Bonnot Clemence , Shrestha Him K. , Hettich Robert L. , Veneault-Fourrey Claire , Martin Francis , Abraham Paul E.
Published: June 2020

Small peptides that are proteolytic cleavage products (PCPs) of less than 100 amino acids are emerging as key signaling molecules that mediate cell-to-cell communication and biological processes that occur between and within plants, fungi, and bacteria. Yet, the discovery and characterization of these molecules is largely overlooked. Today, selective enrichment and subsequent characterization by mass spectrometry–based sequencing offers the greatest potential for their comprehensive characterization, however qualitative and quantitative performance metrics are rarely captured. Herein, we addressed this need by benchmarking the performance of an enrichment strategy, optimized specifically for small PCPs, using state-of-the-art de novo–assisted peptide sequencing. As a case study, we implemented this approach to identify PCPs from different root and foliar tissues of the hybrid poplar Populus × canescens 717-1B4 in interaction with the ectomycorrhizal basidiomycete Laccaria bicolor. In total, we identified 1,660 and 2,870 Populus and L. bicolor unique PCPs, respectively. Qualitative results supported the identification of well-known PCPs, like the mature form of the photosystem II complex 5-kDa protein (approximately 3 kDa). A total of 157 PCPs were determined to be significantly more abundant in root tips with established ectomycorrhiza when compared with root tips without established ectomycorrhiza and extramatrical mycelium of L. bicolor. These PCPs mapped to 64 Populus proteins and 69 L. bicolor proteins in our database, with several of them previously implicated in biologically relevant associations between plant and fungus.
Bacillus pumilus LZP02 Promotes Rice Root Growth by Improving Carbohydrate Metabolism and Phenylpropanoid Biosynthesis
Authors: Liu Hong , Wang Zhigang , Xu Weihui , Zeng Jin , Li Lixin , Li Shenglin , Gao Zheng
Published: June 2020

Elucidation of the underlying mechanisms of plant growth promotion of rhizobacteria is very important. This study explored the mechanism by which Bacillus pumilus LZP02 promotes growth in rice roots through proteomic, transcriptomic, and metabolomic techniques. The results showed that B. pumilus LZP02 promoted the absorption of phosphorous, calcium, and magnesium ions by colonization of rice roots and enhanced peroxidase, catalase, superoxide dismutase, and Ca2+Mg2+ adenosine triphosphatase activities and chlorophyll contents in rice. The proteomic results showed that most of the differentially expressed proteins were involved in carbohydrate metabolism and that the biosynthesis of other secondary metabolites was also increased. According to RNA-seq and reverse transcription-quantitative PCR analyses, expression of some genes involved in carbohydrate metabolism and phenylpropanoid biosynthesis was upregulated in rice roots. Regarding metabolomics, phenylpropanoid biosynthesis, starch and sucrose metabolism, the pentose phosphate pathway, and glyoxylate and dicarboxylate metabolism were increased. The results indicated that B. pumilus LZP02 promoted the growth of rice roots by enhancing carbohydrate metabolism and phenylpropanoid biosynthesis.
Clinical significance of increased peripheral venous blood adipocyte-specific protein FABP4 after joint replacement
Authors: Wang Zhuo , Buqi Na , Zhang Pingji , Wang Yanxun , Lv Yanwei , An Guisheng
Published: June 2020

A new method of diagnosing fat embolism (FE) at the molecular level was proposed, and the diagnostic value of adipocyte-specific protein fatty acid-binding protein 4 (Homo sapiens [human]) gene ID = 2167 (FABP4) for FE was preliminarily explored. Eight joint replacement patients, 5 internal medicine patients, and 6 healthy persons were recruited. Serum of internal medicine patients, healthy people, and patients before and 24 hours after joint replacement were taken as study samples. Subcutaneous adipose, intra-articular adipose and intramedullary yellow bone marrow of patients undergoing joint replacement were taken as study samples. The level of FABP4 in the above samples was detected by enzyme-linked immunoassay. Normal distribution was tested. Paired sample T test was used for self-control. Univariate analysis of variance was used for multigroup comparison.

There was no significant difference in serum FABP4 level between healthy persons, medical patients, and preoperative patients. The FABP4 level in yellow bone marrow and subcutaneous adipose was significantly higher than that in serum of healthy people, medical patients, and preoperative patients. FABP4 level in the serum after joint replacement was significantly higher than that before joint replacement. FABP4 may be a specific indicator of FE diagnosis, but further studies are needed to confirm its clinical value.
All-inside versus inside-out suture techniques in arthroscopic meniscus repair
Authors: Lin Yanming , Zhao Jiasong , Qiu Heng , Huang Yong
Published: June 2020

Background:

With advancements in our understanding of meniscal function, treatment options for meniscal injuries have evolved considerably over the past few decades. The aim of the current study was to compare the all-inside and inside-out techniques with regard to retear rate, functional outcomes, and perioperative complications in patients who had undergone arthroscopic meniscus repair. We hypothesized that there was no significant difference between the 2 groups in terms of postoperative outcomes after arthroscopic meniscus repair.

Methods:

This study was a prospective randomized blinded study, with a parallel design and an allocation ratio of 1:1 for the treatment groups. This study was approved by the Institutional Review Board in our hospital and written informed consent was obtained from all subjects participating in the trial. It was carried out in accordance with the principles of the Helsinki Declaration. A total of 70 patients who meet inclusion criteria are randomized to either all-inside or inside-out group. The primary outcome measure was retear rate. Retear was determined by repeat arthroscopic evaluation of patients with follow-up for symptoms of persistent or new pain, catching, or locking that was possibly related to the meniscal repair. Secondary outcomes included disease-specific quality of life measurement with the Western Ontario Meniscal Evaluation Tool, range of motion, operative time, and adverse events at surgery or throughout the follow-up period.

Results:

This study has limited inclusion and exclusion criteria and a well-controlled intervention.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5589).
Comparison of clinical efficacy between robotic-laparoscopic excision and traditional laparoscopy for rectal cancer
Authors: Chen Zhen , Zhu Zhuo Li , Wang Pingxi , Zeng Fanwei
Published: June 2020

Backgrounds:

Laparoscopic surgery, robot-assisted surgery and open surgery are the most commonly consumed surgical techniques in daily living. Considering that in recent years, the situation of choosing laparoscopic surgery and robot-assisted surgery to treat rectal cancer in China is prosperous. Meanwhile, researches lacked in the comparison part between the 2, so we will systematically compare the clinical efficacy of robot-assisted resection and traditional laparoscopic resection for rectal cancer.

Methods and analysis:

We will search Clinical research literature published before January 2020 in PubMed, Embase, the Cochrane library, Science Network, Wan Fang database, Chinese national knowledge infrastructure, and Chinese biomedicine that evaluate the correlation of rectal cancer with Leonardo's robot and traditional laparoscopy, from inception to July 2019. Weighted mean difference and odds ratio were used to compare the efficacy of robot-assisted resection versus conventional laparoscopic resection for rectal cancer, and the main indicators are operation time, complication rate, conversion rate, blood loss, and length of stay.

Results and conclusion:

This study will systematically evaluate the clinical efficacy of robot-assisted resection and traditional laparoscopic resection for rectal cancer, thus providing evidence to the clinical application. The results will be published in a peer-reviewed journal.

Ethics and dissemination:

No ethical approval and participant consent are required, since this study data is based on published literature. The results of the study will be submitted to a peer-reviewed journal.

PROSPERO registration number: CRD42020172161
Biological reconstruction in the treatment of extremity sarcoma in femur, tibia, and humerus
Authors: Yao Weitao , Cai Qiqing , Wang Jiaqiang , Zhang Peng , Wang Xin , Du Xinhui , Niu Xiaohui
Published: June 2020

To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision.

This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft.

The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement.

Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.
Characterization of circulating myeloma tumor cells by next generation flowcytometry in scleromyxedema patient: a case report
Authors: Taha Ruba Y. , Hasan Saba , Ibrahim Firyal , Chantran Yannick , Sabah Hesham El , Sivaraman Siveen , Bozom Issam Al , Sabbagh Ahmad Al , Garderet Laurent , Omri Halima El
Published: June 2020

Introduction:

Scleromyxedema (rare cutaneous mucinosis), is characterized by the formation of lichenoid papules and presence of Serum monoclonal IgG in most cases, or all; after repeated testing.

Patient concerns

: The patient is a 51-year-old male presented with thick, disfiguring elephant-like erythematous skin folds over the forehead, papular shiny eruptions over ears and trunk and waxy erythematous papules over arms and hands without dysphagia or respiratory or neurologic symptoms

Diagnosis

: Skin biopsy from right arm was consistent with scleromyxedema. Serum cryoglobulin was reported negative. Complete blood count and routine blood biochemistry were normal. Thyroid function tests were normal. Serum protein electrophoresis and immunofixation showed monoclonal band of 14.5 g/L typed as IgG lambda.

Interventions

: Our patient was refractory to lenalidomide however improved clinically on immunoglobulins infusions on monthly basis without change in the MGUS level.

Outcomes

: NGF analysis revealed approximately 0.25% Lambda monotypic plasma cells in the bone marrow expressing CD38, CD138, and CD27 with aberrant expression of CD56 and were negative for CD45, CD19, CD117, and CD81. We also detected 0.002% circulating plasma cells (PCs) in peripheral blood.

Conclusion

: The immunophenotype of circulating tumor cells (CTCs) remain close to the malignant PCs phenotype in the BM. Hence, we report NGF approach as a novel diagnostic tool for highly sensitive MRD detection in plasma cell dyscrasias including scleromyxedema.
Effect of Shenqi compound on inflammatory markers and glycemic measures among diabetes mellitus
Authors: Yang Yan , Fu Xiaoxu , Zhong Wen , Hu Zhipeng , Tian Yuan , Zhou Hui , Gao Hong , Xie Chunguang
Published: June 2020

Background:

Diabetes is a chronic disease characterized by chronic hyperglycemia, absolute or relative deficiency of insulin secretion, and chronic inflammation. Shenqi compound (SC) is a traditional Chinese medicine formula widely used in the treatment of diabetes and diabetic complications. Although many randomized clinical trials have proved that SC can benefit a lot from diabetes and its complications, the systematic evaluation of the effect of SC on diabetic blood glucose control and inflammatory markers has not yet appeared. The purpose of this study is to provide evidence that the therapeutic effect of SC on diabetes and its multiple system complications is related to its control of blood glucose and inflammatory mediators.

Methods:

Three English database and 4 Chinese medical databases will be searched from its inception to May 2020. Then 2 methodological trained researchers will screen the qualified articles by reading the title, abstract, and full texts according to an established inclusion and exclusion criteria. The assessment of risk of bias will be conducted by using the Cochrane collaboration's tool. We will conduct meta-analyses for fasting blood glucose, postprandial blood glucose, glycated hemoglobin, tumor necrosis factor, C-reactive protein or high-sensitivity C-reactive protein, and other outcomes. The heterogeneity of data will be evaluated by Cochrane X
2 and I
2 tests. Subgroup analysis will also be carried out. We will conduct sensitivity analysis to evaluate the stability of the results, funnel plot analysis, and Egger test to evaluate the publication bias, and assessment for the quality of evidence by the grading of recommendations assessment, development, and evaluate system.

Results:

The results of our research will be published in a peer-reviewed journal.

Conclusion:

In this study, we will systematically evaluate the influences of SC on glycemic measures and inflammatory markers of diabetes mellitus. Our research is supposed to provide evidence-based support for clinical practice.

Registration number:

INPLASY202040179.
Association of trimethylamine N-oxide with coronary atherosclerotic burden in patients with non-ST-segment elevation myocardial infarction
Authors: Bin Waleed Khalid , Lu Yongkang , Liu Qiang , Zeng Fanfang , Tu Hong , Wei Yi , Xu Shuai , Zhang Zhiling , Rongfeng Yang , Fan Ailing , Altaf Afrasyab , Chang Junlei , Wang Lili
Published: June 2020

Background:

Recently, trimethylamine N-oxide (TMAO) unexplained gut microbe has been proposed as a promising risk factor for atherosclerotic cardiovascular disease (CVD) pathogenesis and adverse events. The relationship of TMAO with coronary atherosclerotic burden has been evaluated in patients with stable coronary artery disease and ST-segment elevation myocardial infarction, but still needs to be explored in newly diagnosed non-ST-segment elevation myocardial infarction (NSTEMI) patients.

Material and methods:

A prospective, single-center, SZ-NSTEMI trial (ChiCTR1900022366) is underway to investigate the relationship of TMAO with the severity and prognosis of coronary atherosclerosis in newly diagnosed NSTEMI patients who will undergo coronary angiography with primary percutaneous coronary intervention (pPCI). The primary endpoint of the study will be assessed the association of TMAO with coronary atherosclerotic severity quantify by the number of diseased coronary arteries and SYNTAX score after the coronary angiography. The secondary endpoints will be identified the TMAO as a prognostic biomarker for the short (1 month) and long-term (12 months) major cardiovascular and cerebrovascular events (MACCEs) rate including myocardial infarction, target vessel revascularization, stroke, heart failure, all-cause rehospitalization, and all-cause mortality after the pPCI. The blood samples will be collected from each patient before the procedure to measure the TMAO by isotope dilution high-performance liquid chromatography. In conclusion, SZ-NSTEMI will be the first cohort that will be investigated the association of TMAO with the severity and prognosis of coronary atherosclerotic burden in NSTEMI patients, aiming to identify TMAO as a predictor and a prognostic biomarker.
Antrodia cinnamomea is a potentially effective complementary medicine for adjuvant therapy against breast cancer with bone metastasis
Authors: Long Huei , Hu Chi-Tan , Prijatelj Vesna , Weng Ching-Feng
Published: June 2020

Rationale:

Palbociclib (PAL) is a first-in-class selective inhibitor of the cyclin-dependent kinases 4 (CDK4) and CDK6 and is indicated for the treatment of hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) in combination with fulvestrant (FUL) in postmenopausal women. Antrodia cinnamomea (AC), a well-known Chinese folk medicine in Taiwan, possesses numerous biological capabilities, most notably an anti-tumor effect. However, the clinical use of AC as complementary medicine combined with adjuvant therapy is unexplored. In this case report, we evaluated AC combined with PAL plus FUL to reduce the tumor burden in an MBC patient.

Patient concerns:

A Slovenian woman diagnosed with relapsed bone metastases of breast cancer (BC) was unable to undergo surgery and refused radiation therapy due to fear of side effects; she also feared the side effects of adjuvants. However, she was eager to live with a high quality of life.

Diagnosis:

Stage IV, HR-positive/HER2-negative BC with relapse of bone metastases.

Interventions:

After diagnosis of relapse of bone metastases, she received adjuvant with PAL plus FUL. Additionally, she chose to take AC orally (10 g/d).

Outcomes:

The pain was mostly relieved, and the side effects of adjuvant therapy reduced. Magnetic resonance imaging revealed reduction of tumor size at the fifth month of adjuvant therapy plus AC. After 14 months of adjuvant therapy plus AC, the tumors at the thoracic vertebrae T1 and T3 were found to have shrunk from 35.2 and 12.0 mm to 28.1 and 9.9 mm, respectively. Remarkably, no further metastases were observed.

Lessons:

According to the circulating tumor cells (CTCs) test data, AC had better anti-tumor efficacy on active tumor cells than PAL plus FUL. Thus, AC could be an effective complementary medicine for adjuvant therapy in patients with HR-positive/HER2-negative MBC. Interestingly, continued elevation of carcinoma antigen 15-3 and lactate dehydrogenase levels but decreasing levels of alkaline phosphatase were observed, which may be indicative of the potent efficacy of treatment resulting in massive tumor cell death. The CTCs test may be a sensitive approach to monitor the progression of BC and subsequently evaluate the efficiency of therapy.
Efficacy and safety of low-dose glucocorticoids combined with methotrexate and hydroxychloroquine in the treatment of early rheumatoid arthritis
Authors: Hua Li , Du Hongwei , Ying Mingliang , Wu Honghua , Fan Jia , Shi Xiaowei
Published: June 2020

Introduction:

Glucocorticoids (GCs), especially low-dose GCs, are commonly prescribed for rheumatoid arthritis (RA), although the risk/benefit ratio is controversial. A randomized, double-blind clinical trial was performed to evaluate the efficacy and safety of low-dose oral GCs combined with methotrexate (MTX) and hydroxychloroquine (HCQ) in early RA (ERA).

Methods:

Eighty untreated ERA patients were randomized into the trial (GCs + MTX + HCQ) and control (placebo + MTX + HCQ) groups, for 1-year treatment. Therapeutic evaluation indices were American College of Rheumatology (ACR) 20 of ACR, disease activity score (DAS) 28- erythrocyte sedimentation rate (ESR), visual analog scale scores, joint function, health assessment questionnaire-disability index score, morning stiffness duration, C-reaction protein and ESR. The clinical indicators were evaluated pre-treatment and at 1st, 3th, 6th and 12th month of treatment. The MRI data of single joint (ie, the most swollen joint) for each patient were acquired with a revised OMERACT RAMRIS Scoring System before and after treatment. The correlation analysis was adopted to confirm whether the efficacy of GC treatment is related to the time of RA onset. The side effects (eg, gastrointestinal reactions, liver dysfunction, upper respiratory tract infection, leukocyte reduction) were also monitored.

Results:

At 1st month, 55% and 20% cases in the experimental and control groups achieved ACR20 response, respectively, indicating a significant difference (χ

2
 = 16.157, P < .001). This trend continued until 6th month. At 12th month, the number of patients achieved ACR20 response was similar in both groups. At 1st to 6th month, DAS28- ESR scores in the experimental group were significantly lower than control values (all p < .05). The experimental group showed improved inflammation, quality of life and radiological symptoms. Bone erosion remained unchanged in the experimental group, while worsening in control group. Correlation coefficients between RA duration and DAS28-ESR score were 0.496, 0.464, 0.509, and 0.550 at 1st, 3th, 6th, and 12th month, respectively. No differences were found in adverse events between the 2 groups.

Conclusions:

Low-dose GCs combined with MTX and HCQ significantly achieves disease remission indexed by ACR20 and DAS28-ESR, and improves clinical and radiological outcomes in ERA patients at the early stage, with superiority over placebo + MTX + HCQ, without enhancing adverse reactions.
Failure of early extubation among cases of coronavirus disease-19 respiratory failure
Authors: Zhang Jingchen , He Xujian , Hu Jia , Li Tong
Published: June 2020

Rationale:

Extubation strategy for mechanically ventilated patients with Coronavirus Disease 19 is different from that for patients with other viral pneumonia. We reported 2 cases of Coronavirus Disease 19 receiving tracheal intubation twice during the hospitalization.

Patient concerns:

Two elderly patients with onset of fever and upper respiratory tract infection were confirmed as Coronavirus Disease 19, 1 of whom had chronic obstructive pulmonary disease previously. With active antiviral and noninvasive respiratory supportive therapy, there was no improvement, thus mechanical ventilation (MV) was adopted. Combining with symptomatic and supportive treatment, their oxygenation recovered and then extubation was carried out. However, 96 hours later, they underwent endotracheal intubation again due to their Coronavirus Disease 19 progression.

Diagnosis:

Critically ill Coronavirus Disease 19 requiring tracheal intubation owing to respiratory failure with lung.javascript.

Interventions:

Initial Strategy for respiratory failure included endotracheal intubation, MV, antiviral treatment and cortisol in both cases. When extubation criteria were satisfied, early discontinuation of MV was conducted, then rehabilitation exercise and nutritional support followed. However, 96 hours later, the disease progressed leading to respiratory failure again, thus reintubation was performed. Later, veno-venous extracorporeal membrane oxygenation was performed owing to aggravation of respiratory failure, assisted by prone position treatment and sputum drainage, then status became stable and stepped into recovery stage.

Outcomes:

Both patients underwent reintubation, and their MV time and Intensive care unit residence time were prolonged. Through prone position treatment, sputum drainage and awake extracorporeal membrane oxygenation strategy, patient has been transferred to rehabilitation unit in Case 1, and patient in Case 2 has been in recovery stage as well with stable pulmonary status and was expected to receive evaluation in recent future.

Lessons:

Course of Coronavirus Disease 19 is relatively longer, and failure rate of simple early extubation seemes higher. To reduce the likelihood of reintubation and iatrogenic injury, individualized assessment is recommended.
Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults
Authors: Masyuko Sarah J. , Page Stephanie T. , Kinuthia John , Osoti Alfred O. , Polyak Stephen J. , Otieno Fredrick C. , Kibachio Joseph M. , Mogaka Jerusha N. , Temu Tecla M. , Zifodya Jerry S. , Otedo Amos , Nakanjako Damalie , Hughes James P. , Farquhar Carey
Published: June 2020

To determine the prevalence and correlates of metabolic syndrome (MetS) and compare 10-year cardiovascular disease (CVD) risk among Kenyan adults with and without HIV infection.

We conducted a cross-sectional study among adults ≥30 years of age with and without HIV infection seeking care at Kisumu County Hospital. Participants completed a health questionnaire and vital signs, anthropomorphic measurements, and fasting blood were obtained. MetS was defined using 2009 Consensus Criteria and 10-year Atherosclerotic CVD (ASCVD) risk score was calculated. Chi-square, independent t tests, Wilcoxon ranksum test and multivariable logistic regression were used to determine differences and associations between HIV and MetS, CVD risk factors and ASCVD risk score.

A total of 300 people living with HIV (PLWHIV) and 298 HIV-negative participants with median age 44 years enrolled, 50% of whom were female. The prevalence of MetS was 8.9% overall, but lower among PLWHIV than HIV-negative participants (6.3% vs 11.6%, respectively; P = .001). The most prevalent MetS components were elevated blood pressure, decreased high density lipoprotein, and abdominal obesity. Adjusting for covariates, PLWHIV were 66% less likely to have MetS compared to HIV-negative participants (adjusted odds ratio [aOR] 0.34; 95% confidence interval [95%CI] 0.18, 0.65; P = .005). Median ASCVD risk score was also lower among PLWHIV compared to HIV-negative participants (1.7% vs 3.0%, P = .002).

MetS was more common among HIV-negative than HIV-positive adults, and HIV-negative adults were at greater risk for CVD compared to PLWHIV. These data support integration of routine CVD screening and management into health programs in resource-limited settings, regardless of HIV status.
Self-inflicted neck wounds under influence of lysergic acid diethylamide
Authors: Le Daré Brendan , Gicquel Thomas , Baert Alain , Morel Isabelle , Bouvet Renaud
Published: June 2020

Rationale:

Lysergic acid diethylamide (LSD) is a highly potent psychedelic drug derived from ergot alkaloids. The available literature data derived from controlled studies or usage in a medical setting seem reassuring; however the literature contains very rare cases of fatal self-inflicted injuries associated with LSD exposure. The behavioral disorder that created the conditions conducive to death is a maladaptive or irrational response to the psychiatric manifestations induced by the substance.

Patient concern:

Here, we report the case of a 26-year-old man found dead with large neck wounds in a locked house. No medical history other than recreational use of alcohol and narcotics was reported as well as any history of psychotic disease. The entirety of the other investigations carried out did not demonstrate the presence of a third party at the place of death and a dropper bottle containing LSD was found near the body.

Diagnosis:

We report the first case of fatal self-inflicted neck wounds with a cutting instrument in the context of acute exposure to LSD in a patient with no psychiatric history and without suicidal symptoms at the time of the self-aggressive act.

Intervention and outcomes:

In the present work, we used a validated method using liquid chromatography coupled with mass spectrometry for simultaneous quantification of LSD and its metabolites (O-H-LSD and Nor-LSD) in whole blood and urine samples. LSD and O-H-LSD were respectively found at 1460 and 182 pg/mL in blood. In the urine, the concentrations of LSD, nor-LSD, O-H-LSD were, respectively, 3670, 201, and 4890 ng/L.

Lessons:

This observation is particularly relevant in view of the resurgence of interest in the therapeutic use of LSD, notwithstanding the fact that the literature has not demonstrated a link between suicidal risk and acute or chronic exposure to LSD.
A risk stratification scoring system for new-onset atrial fibrillation after ischemic stroke
Authors: Chen Yung-Lung , Wang Hui-Ting , Chen Huang-Chung , Liu Wen-Hao , Hsueh Shukai , Chung Wen-Jung , Wu Po-Jui , Liu Chi-Hung , Chung Chang-Ming , Lin Yu-Sheng
Published: June 2020

Atrial fibrillation (AF) is a major independent risk factor of stroke and anticoagulation therapy is needed in patients with AF after ischemic stroke. However, the detection rate of AF is low after ischemic stroke. Developing a prediction model for newly diagnosed AF after ischemic stroke will help to assess the subclinical AF.

We identified 98,103 patients with diabetes mellitus (DM) and 261,893 patients without DM, who were not AF history and admitted for newly ischemic stroke from the National Health Insurance Research Database in Taiwan. The prediction model for 3-year incidence of AF after ischemic stroke was derived from multivariate logistic regression and also the accuracy rate of the prediction model was compared with CHA2DS2-VASC and CHADS2 scores as a reference.

Four thousand nine hundred seventy six patients in the DM cohort and 16,127 patients in the non-DM cohort developed AF during 3 years of follow-up. The variables in the point-based prediction model for non-DM patients (range: -3–28), included age, heart failure, coronary artery disease, gout, obstructive pulmonary disease, hypertension, female, and statin use, while those for DM patients (range: -2–30) included age, heart failure, coronary artery disease, chronic kidney disease, hypertension, obstructive pulmonary disease, and statin use. Compared to the CHADS2 and CHA2DS2-VASc scoring systems, this scoring system was better at predicting 3-year risk of AF after ischemic stroke in both cohorts.

This model might be useful in evaluating the benefit of insertable cardiac monitor implantation and anticoagulation agents in individual patients after ischemic stroke.
Enhanced recovery after surgery (ERAS) protocols in patients undergoing radical cystectomy with ileal urinary diversions
Authors: Vlad Olaru , Catalin Baston , Mihai Harza , Adrian Preda , Manuela Olaru , Gener Ismail , Ioanel Sinescu
Published: June 2020

Background:

Enhanced Recovery After Surgery (ERAS) protocols were introduced in clinical practice to reduce complication rates and hospital stay. We performed a randomized controlled single center study to evaluate perioperative benefits of an adapted ERAS protocol in patients with bladder cancer who underwent radical cystectomy (RC) and ileal urinary diversions (IUD).

Materials and methods:

Forty five from 90 consecutive randomized patients were enrolled in an adapted ERAS protocol. Length of stay, diet issues, return of bowel function, readmission rates and complications were examined.

Results:

Among patients following ERAS protocol, we found a significant reduction in time to first flatus (1 vs 5 days, P < .001), time to first stool (2 vs 5 days, P < .001), time to normal diet (5 vs 6 days, P < .001) and length of stay (16 vs 18 days, P < .001). Also, postoperative ileus at less than 4 days was lower than in non-ERAS patients (15.6% vs 24.4%), but with a marginal trend toward significance (P = .05). Readmission rate was lower in the ERAS group, but the difference did not reach statistical significance. We also found a lower readmission and complication rate in patients with ERAS protocol (6.6% vs 11.1%, P = .23 and 46.6% vs 57.5%, P = .29, respectively).

Conclusions:

Implementation of ERAS protocol for patients undergoing RC in our center was associated with a significant reduction in the time to the first flatus, time to the first stool, time to a normal diet, length of hospital stay.