bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence risk of peripheral edema in cancer patients treated with PD-1/PD-L1 inhibitors: A PRISMA guideline systematic review and meta-analysis
Authors: Tian Yuan , Huang Alan , Tian Mei , Wang Kaiyong , Dang Qi , Zhang Caiqing , Liu Hongmei , Zhao Junyan , Yang Xiaowei , Zhang Chi , Guo Liang , Chen Feng
Published: September 2022

Purpose:

To elucidate the relationship between peripheral edema and programmed cell death-1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors, the meta-analysis was performed.

Method:

Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses, all-grade and grade 3-5 of peripheral edema data extracted from clinical trials were taken into account for the final comprehensive assessments.

Results:

Twenty-seven PD-1/PD-L1-related clinical trials with peripheral edema data were collected. Compared with chemotherapy (PD-1/PD-L1 vs chemotherapy), the risk of developing peripheral edema for all-grade was much lower (odds ratio [OR] = 0.36, 95% confidence interval [CI]: [0.23, 0.56], Z = 4.55 [P < .00001]). When PD-1/PD-L1 plus chemotherapy were compared with chemotherapy, no significant analysis results for all-grade was found (OR = 1.15, 95% CI:[0.93, 1.44], I
2 = 25%, Z = 1.27 [P = .20]). Similar risk trends could also be found when the incidence risk of peripheral edema for grade 3–5 was evaluated. No obvious publication bias was identified throughout the total analysis process.

Conclusion:

The effect of PD-1/PD-L1 inhibitor on the risk of developing peripheral edema was weaker than that of chemotherapy, and the combination with chemotherapy slightly increased the incidence risk of developing peripheral edema without statistical significance.
Assessment of body composition, metabolism, and pulmonary function in patients with myotonic dystrophy type 1
Authors: Kikuchi Kazuto , Satake Masahiro , Furukawa Yutaka , Terui Yoshino
Published: September 2022

Abnormal body composition in myotonic dystrophy type 1 (DM1) are affected by energy intake above resting energy expenditure (REE). We aim to investigate the characteristics and relationship between body composition, REE, and pulmonary function in patients with DM1, and to examine their changes in 1 year. The study design was a single-center, cross-sectional, and longitudinal study of body composition, REE characteristics, and pulmonary function. Twenty-one male patients with DM1 and 16 healthy volunteers were registered in the study. Body composition was measured using dual-energy X-ray absorptiometry (DEXA). Fat mass (FM) index (kg/m2), fat-FM index (kg/m2), and skeletal mass index (kg/m2) were calculated. The measurements were taken breath by breath with a portable indirect calorimeter. The REE was calculated using the oxygen intake (VO2) and carbon dioxide output (VCO2) in the Weir equation. Basal energy expenditure (BEE) was calculated by substituting height, weight, and age into the Harris–Benedict equation. The study enrolled male patients with DM1 (n = 12) and healthy male volunteers (n = 16). Patients with DM1 (n = 7) and healthy volunteers (n = 14) could be followed in 1 year. The body composition of patients with DM1 was significantly higher in the FM index and significantly lower in the fat-FM index and skeletal mass index. The REE of patients with DM1 was significantly lower and was not associated with body composition. Patients with DM1 had poor metabolism that was not related to body composition. FM was high and lean body mass was low.
Two novel predictive biomarkers for osteosarcoma and glycolysis pathways: A profiling study on HS2ST1 and SDC3
Authors: Yang Guozhi , Jiang Jie , Yin Ruifeng , Li Zhian , Li Lei , Gao Feng , Liu Chong , Zhan Xinli
Published: September 2022

Introduction:

Prognostic biomarkers for osteosarcoma (OS) are still very few, and this study aims to examine 2 novel prognostic biomarkers for OS through combined bioinformatics and experimental approach.

Materials and methods:

Expression profile data of OS and paraneoplastic tissues were downloaded from several online databases, and prognostic genes were screened by differential expression analysis, Univariate Cox analysis, least absolute shrinkage and selection operator regression analysis, and multivariate Cox regression analysis to construct prognostic models. The accuracy of the model was validated using principal component analysis, constructing calibration plots, and column line plots. We also analyzed the relationship between genes and drug sensitivity. Gene expression profiles were analyzed by immunocytotyping. Also, protein expressions of the constructed biomarkers in OS and paraneoplastic tissues were verified by immunohistochemistry.

Results:

Heparan sulfate 2-O-sulfotransferase 1 (HS2ST1) and Syndecan 3 (SDC3, met all our requirements after screening. The constructed prognostic model indicated that patients in the high-risk group had a much lower patient survival rate than in the low-risk group. Moreover, these genes were closely related to immune cells (P < .05). Drug sensitivity analysis showed that the 2 genes modeled were strongly correlated with multiple drugs. Immunohistochemical analysis showed significantly higher protein expression of both genes in OS than in paraneoplastic tissues.

Conclusions:

HS2ST1 and SDC3 are significantly dysregulated in OS, and the prognostic models constructed based on these 2 genes have much lower survival rates in the high-risk group than in the low-risk group. HS2ST1 and SDC3 can be used as glycolytic and immune-related prognostic biomarkers in OS.
Identification and validation of the necroptosis-related gene signature related to prognosis and tumor immune in hepatocellular carcinoma
Authors: Xiang Zhiping , Mranda Geofrey Mahiki , Zhou Xingguo , Xue Ying , Wang Yu , Wei Tian , Liu Junjian , Ding Yinlu
Published: September 2022

Background:

Hepatocellular carcinoma (HCC) is the sixth most common cancer, which is characterized by complicated etiology, excessive heterogeneity, and poor prognosis. Necroptosis is a new kind of programmed cell death, which is intently associated with the occurrence and development of tumors. Although researchers have had a deep understanding of necroptosis in recent years, the expression level of necroptosis-related genes in HCC and its relationship with the survival time of HCC patients are not clear.

Methods:

According to the expression of necroptosis-related genes and the survival of HCC patients, HCC patients in the TCGA database were divided into 2 groups that were relatively independent of each other. The genes related to the survival time of HCC patients were screened from the 2 groups of differentially expressed genes. By using the Least Absolute Shrinkage and Selection Operator Cox regression analysis, the optimal λ value was obtained, and the 10-gene signature model was established.

Results:

According to the median risk score of the TCGA cohort, HCC patients were averagely divided into high- and low-risk groups. Compared with the low-risk group, the death toll of the high-risk group was relatively higher and the survival time was relatively shorter. Principal component analysis and t-distributed stochastic neighbor embedding analysis showed that there was a significant separation between high- and low-risk groups. Through Kaplan–Meier analysis, it was found that the survival time of HCC patients in the high-risk group was significantly shorter than that in the low-risk group. Through receiver operating characteristic analysis, it was found that the sensitivity and specificity of the model were good. We also make a comprehensive analysis of the international cancer genome consortium database as a verification queue and prove the reliability of the 10-gene signature model. Gene Ontolog, Kyoto Encyclopedia of Genes and Genomes, and single-sample gene set enrichment analysis showed that many biological processes and pathways related to immunity had been enriched, and the antitumor immune function was weakened in the high-risk population.

Conclusion:

The risk score can be considered as an independent prognostic factor to predict the prognosis of patients with HCC, and necroptosis-related genes are also closely related to tumor immune function.
Evaluation of continuous intravenous lidocaine on brain relaxation, intraoperative opioid consumption, and surgeon’s satisfaction in adult patients undergoing craniotomy tumor surgery: A randomized controlled trial
Authors: Chandra Susilo , Pryambodho Pry , Omega Andy
Published: September 2022

Background:

In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon’s satisfaction in adult patients undergoing craniotomy tumor removal.

Methods:

A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon’s satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min.

Results:

All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon’s satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study.

Conclusions:

Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.
: A case report of re-challenge of immune checkpoint inhibitors after immune-related neurological adverse events: Review of literature
Authors: Moon Heesung , Kim Seul-Gi , Kim Seung Ki , Kim Jinkwon , Lee Seung Ryeol , Moon Yong Wha
Published: September 2022

Introduction:

The indications for immune checkpoint inhibitors (ICIs) are expanding for various cancers because of their durable responses and tolerable safety profiles. Immune-related adverse events (irAEs), including neurological adverse events (nAEs), are associated with ICIs therapy. However, there have been few studies on whether re-challenge with ICIs can be clinically acceptable after neurological AE has improved.

Patient concerns:

A 69-year-old woman with recurrent ovarian cancer undergoing palliative chemotherapy was admitted to our hospital with sudden development of diplopia, dizziness, and gait instability. The patient was administered ICI therapy with anti-angiogenic agents for 9 weeks for 3 cycles.

Diagnosis:

We performed neurological examination, brain imaging, nerve conduction studies, and serology tests. The patient was diagnosed with Guillain–Barré syndrome variant, an immune-mediated polyneuropathy characterized by a triad of ataxia, areflexia, and ophthalmoplegia.

Intervention:

After prompt discontinuation of pembrolizumab, the patient was taken intravenous methylprednisolone (2 mg/kg) was administered for 5 days, and her symptoms were partially resolved. With the addition of immunoglobulin 0.4 g/kg for 5 days, her symptoms gradually improved.

Outcomes:

The patient’s neurological symptoms improved after immunosuppressive therapy, without sequelae. The NCV showed normal nerve conduction. Unfortunately, because there was little evidence for pembrolizumab rechallenge, pembrolizumab therapy was permanently discontinued, and the tumors eventually progressed.
Successful treatment of metastatic vulvar malignant melanoma with toripalimab: A rare case report and review of the literature
Authors: Li Yi-Hui , Zhou Yang , Zhang Guang-Ju , Wang Yu-Wei , Wang Jian-Gong , Wang Xiao-Hong , Li Yu-Feng
Published: September 2022

Rationale:

Vulvar melanoma is a rare and aggressive tumor with a high risk of local recurrence and distant metastasis. The prognosis is poor with a 5-year overall survival rate of only 46.6%. Management of vulvar melanoma remains a clinical challenge. Recent evidences have shown that immune checkpoint inhibitors are effective in the treatment of vulvar melanoma.

Patient concerns and diagnoses:

A 63-year-old woman with vulvar malignant melanoma suffered inguinal lymph node metastasis after vulvectomy and chemotherapy. She underwent inguinal lymph node dissection and inguinal radiotherapy. The tumor progressed again and she received immunotherapy.

Interventions:

The tumor progressed again, and she was admitted to our hospital and received toripalimab combined with apatinib and abraxane.

Outcomes:

After 6 cycles of immunotherapy, the efficacy achieved partial remission. And with toripalimab as maintenance therapy, the patient achieved durable antitumor efficacy and good safety.

Lessons:

In this rare case, the patient with metastatic vulvar malignant melanoma had durable antitumor efficacy and good safety when receiving toripalimab.
Psoas muscle index predicts time to rehospitalization in liver cirrhosis: An observational study
Authors: Hentschel Florian , Schwarz Theresa , Lüth Stefan , Schreyer Andreas G.
Published: September 2022

Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), or Child–Turcotte–Pugh (CTP) do not contain sarcopenia as a variable. For this study, we utilized psoas muscle index (PMI) to objectively determine sarcopenia in hospitalized LC patients, and evaluated it as a predictor of time between discharge and readmission in LC. Abdominal computed tomography and magnetic resonance imaging scans of 65 consecutive LC patients were retrospectively examined to determine PMI. MELD, MELD-Na, and CTP were calculated from clinical data. PMI was then combined with CTP to form an experimental score: CTP sarcopenia (CTPS). For PMI alone and for each score, correlation with time between discharge and readmission for liver-related complications was calculated. PMI was also tested for correlation with sex, body mass index (BMI), MELD, MELD-Na, and CTP. CTPS was most closely correlated with time to readmission (R = 0.730; P < .001), followed by CTP (R = 0.696; P < .001), MELD-Na (R = 0.405; P = .009), and PMI alone (R = 0.388; P = .01). Correlation with MELD (R = 0.354; P = .05) was lowest. Additionally, there were significant differences in PMI between male and female individuals (5.16 vs 4.54 cm2/m2; P = .04) and in BMI between sarcopenic and nonsarcopenic individuals (29.63 vs 25.88 kg/m2; P = .009). Sarcopenia is an independent short-term prognostic factor in LC. By combining data on sarcopenia with CTP, we created an experimental score that predicts time to readmission better than MELD, MELD-Na, or CTP.
Identification of an endoplasmic reticulum stress-associated gene signature to predict the immune status and prognosis of cutaneous melanoma
Authors: Chen Rong , Niu Linjun , Wu Liang , He Youwu , Liu Gang , Hong Kangjie
Published: September 2022

Besides protecting normal cells from various internal and external perturbations, endoplasmic reticulum (ER) stress is also directly related to the pathogenesis of cutaneous melanoma (CM). However, due to the lack of specific molecular biomarkers, ER stress has not been considered a novel treatment target for CM. Here, we identified ER stress-related genes involved in the prognosis of CM patients and constructed an effective model for the prognostic prediction of these patients. First, gene expression data of CM and normal skin tissues from the Genotype-Tissue Expression (GTEx) and The Cancer Genome Atlas (TCGA) databases were retrieved to identify differentially expressed ER stress-related genes in CM. Meanwhile, an independent cohort obtained from the Gene Expression Omnibus (GEO) database was used for validation. The ER stress genes (ZBP1, DIABLO, GNLY, FASLG, AURKA, TNFRSF21, and CD40LG) that were associated with CM prognosis were incorporated into our prognostic model. The functional analyses indicated that the prognostic model was correlated with patient survival, gender, and cancer growth. Multivariate and univariate Cox regressions revealed that the constructed model could serve as an independent prognostic factor for CM patients. The pathway enrichment analysis showed that the risk model was enriched in different immunity and cancer progression-associated pathways. Moreover, the signature model was significantly connected with the immune subtypes, infiltration of immune cells, immune microenvironment, as well as tumor stem cells. The gene function analysis revealed that 7 ER stress genes were differentially expressed in CM patients and were significantly associated with prognosis and several antitumor drugs. Overall, our current model presented predictive value for the prognosis of CM patients and can be further used in the development of novel therapeutic strategies for CM.
Effect of the COVID-19 pandemic restrictions on outcomes of HIV care among adults in Uganda
Authors: Izudi Jonathan , Kiragga Agnes N. , Kalyesubula Philip , Okoboi Stephen , Castelnuovo Barbara
Published: September 2022

Uganda enforced several stringent restrictions such as night-time curfews, travel bans, school closure, and physical and social distancing among others that constituted a national lockdown to prevent the spread of the Coronavirus disease 2019 (COVID-19). These restrictions disrupted the delivery of health services but the impact on outcomes of human immunodeficiency virus (HIV) care has not been rigorously studied. We evaluated the effect of the COVID-19 pandemic restrictions on outcomes of HIV care among people living with HIV (PLHIV) aged ≥15 years in Kampala, Uganda. We designed a nonrandomized, quasi-experimental study using observational data retrieved from six large HIV clinics and used the data to construct two cohorts: a comparison cohort nonexposed to the restrictions and an exposed cohort that experienced the restrictions. The comparison cohort consisted of PLHIV commenced on anti-retroviral therapy (ART) between March 1, 2018, and February 28, 2019, followed for ≥1 year with outcomes assessed in March 2020, just before the restrictions were imposed. The exposed cohort comprised of PLHIV started on ART between March 1, 2019, and February 28, 2020, followed for ≥1 year with outcomes assessed in June 2021. The primary outcomes are retention, viral load testing, viral load suppression, and mortality. We employed inverse probability of treatment weighting using propensity score (IPTW-PS) to achieve comparability between the two cohorts on selected covariates. We estimated the effect of the restriction on the outcomes using logistic regression analysis weighted by propensity scores (PS), reported as odds ratio (OR) and 95% confidence interval (CI). We analyzed data for nine, 952 participants, with 5094 (51.2%) in the exposed group. The overall mean age was 32.7 ± 8.8 years. In the exposed group relative to the comparison group, viral load testing (OR, 1.68; 95% CI, 1.59–1.78) and viral load suppression (OR, 1.34; 95% CI, 1.110–1.63) increased while retention (OR, 0.76; 95% CI, 0.70–0.81) and mortality (OR, 0.75; 95% CI, 0.64–0.88) reduced. Among PLHIV in Kampala, Uganda, viral load testing and suppression improved while retention and mortality reduced during the COVID-19 pandemic restrictions due to new approaches to ART delivery and the scale-up of existing ART delivery models.
An overview of gastrointestinal diseases in patients with COVID-19: A narrative review
Authors: Lin Cheng-Yao , Su Shih-Bin , Chen Kow-Tong
Published: September 2022

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has emerged as a global health concern. This study aimed to review the epidemiology and pathophysiology of COVID-19 and provide evidence for the implementation of control measures.

We utilized several online databases, including MEDLINE (National Library of Medicine, Bethesda, Maryland, USA), PubMed, EMBASE, Web of Science, and Google Scholar, to collect relevant published papers using a combination of the following keywords: “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” “epidemiology,” and “pathophysiology.” The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this study.

Globally, approximately 3–46% of patients with SARS-CoV-2 infection experience gastrointestinal symptoms. The clinical spectrum of COVID-19 is wide, ranging from mild to severe, and even fatal. COVID-19 was initially reported as a respiratory tract disease; however, gastrointestinal symptoms have only recently been reported. COVID-19 Patients with gastrointestinal symptoms may have more severe clinical manifestations and poor prognosis.

This study highlights the need to better understand the mechanisms involved in the development of gastrointestinal symptoms in patients with COVID-19 to prevent the further spread of this pathogen.
A review of cardiovascular benefits of SGLT2 inhibitors
Authors: Zhang Yingxia , Han Qinghua
Published: September 2022

Sodium-glucose cotransporter 2 inhibitor (SGLT2I) is a new type of hypoglycemic drug that targets the kidney. As research continues to advance on this topic, it has been found that SGLT2I has multiple protective effects, such as hypoglycemic, cardio-renal protective, antihypertensive, and lipid-lowering effects. This review discusses the current concepts and possible mechanisms of SGLT2I in the treatment of heart failure, myocardial infarction, hypertension, cardiomyopathy and arrhythmia to provide a reference for clinicians to use drugs more reasonably and scientifically.
The impact of visual cross-modal conflict with semantic and nonsemantic distractors on working memory task: A functional near-infrared spectroscopy study
Authors: Sawamura Daisuke , Tanabe Yoshinobu , Sakuraba Satoshi , Cui Jiahong , Miura Hiroshi , Saito Ryuji , Sugi Masaaki , Watanabe Akihiro , Tokikuni Yukina , Sugawara Kazuhiro , Miyazaki Mitsunori , Miyamoto Reiko , Sakai Shinya
Published: September 2022

Cross-modal conflicts arise when information from multisensory modalities is incongruent. Most previous studies investigating audiovisual cross-modal conflicts have focused on visual targets with auditory distractors, and only a few studies have focused on auditory targets with visual distractors. Moreover, no study has investigated the differences in the impact of visual cross-modal conflict with semantic and nonsemantic competition and its neural basis. This cross-sectional study aimed to characterize the impact of 2 types of visual cross-modal conflicts with semantic and nonsemantic distractors through a working memory task and associated brain activities. The participants were 33 healthy, right-handed, young male adults. The paced auditory serial addition test was performed under 3 conditions: no-distractor and 2 types of visual distractor conditions (nonsemantic and semantic distractor conditions). Symbols and numbers were used as nonsemantic and semantic distractors, respectively. The oxygenated hemoglobin (Oxy-Hb) concentration in the frontoparietal regions, bilateral ventrolateral prefrontal cortex (VLPFC), dorsolateral prefrontal cortex, and inferior parietal cortex (IPC) were measured during the task under each condition. The results showed significantly lower paced auditory serial addition test performances in both distractor conditions than in the no-distractor condition, but no significant difference between the 2 distractor conditions. For brain activity, a significantly increased Oxy-Hb concentration in the right VLPFC was only observed in the nonsemantic distractor condition (corrected P = .015; Cohen d = .46). The changes in Oxy-Hb in the bilateral IPC were positively correlated with changes in task performance for both types of visual cross-modal distractor conditions. Visual cross-modal conflict significantly impairs auditory working memory task performance, regardless of the presence of semantic or nonsemantic distractors. The right VLPFC may be a crucial region to inhibit visual nonsemantic information in cross-modal conflict situations, and bilateral IPC may be closely linked with the inhibition of visual cross-modal distractor, regardless of the presence of semantic or nonsemantic distractors.
Association between homocysteinemia and mortality in CKD: A propensity-score matched analysis using NHANES-National Death Index
Authors: Song Je Hun , Huh Hyuk , Bae Eunjin , Lee Jeonghwan , Lee Jung Pyo , Lee Jong Soo , Kim Gwang Sil , Yoo Kyung Don
Published: September 2022

Hyperhomocysteinemia (HHcy) is considered a risk factor for cardiovascular disease (CVD), including chronic kidney disease (CKD). In this study, we investigated the association between levels of serum homocysteine (Hcy) and mortality, inferred from the presence of CKD. Our study included data of 9895 participants from the 1999 to 2016 National Health and Nutrition Examination Surveys (NHANES). Multivariable-adjusted Cox proportional hazard models using propensity-score, were used to examine dose-response associations between Hcy level and mortality. A total of 9895 participants, 1025 (10.3%) participants were diagnosed with CKD. In a multivariate Cox regression analysis including all participants, Hcy level was significantly associated with all-cause mortality in the nonCKD group, compared to the 1st quartile in the fully adjusted model (2nd quartile: hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.348–2.274, P < .001; 3rd quartile: HR 2.22, 95% CI 1.726–2.855, P < .001; 4th quartile: HR 3.77, 95% CI 2.952–4.830, P < .001). However, this finding was not observed in the CKD group. The observed pattern was similar after propensity score matching. In the nonCKD group, overall mortality increased in proportion to Hcy concentration (2nd quartile: HR 2.19, 95% CI 1.299–3.709, P = .003; 3rd quartile: HR 2.60, 95% CI 1.570–4.332, P < .001; 4th quartile: HR 3.72, 95% CI 2.254–6.139, P < .001). However, the risk of all-cause mortality according to the quartile of Hcy level, did not increase in the CKD group. This study found a correlation between the Hcy level and mortality rate only in the nonCKD group. These altered risk factor patterns may be attributed to protein-energy wasting or chronic inflammation status, that is accompanied by CKD.
Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report
Authors: Shimada Akie , Yamamoto Taira , Dohi Shizuyuki , Yokoyama Yasutaka , Endo Daisuke , Tabata Minoru
Published: September 2022

Rationale:

Although surgical treatment strategies for patients with extensive thoracic aortic disease involving the aortic arch have improved considerably, the impact of stent graft length and placement site on aortic remodeling at long-term follow-up is not fully understood, and the protection of the Adamkiewicz artery (AKA) using the frozen elephant trunk (FET) method is also unclear.

Patient concerns:

The patient was a 69-year-old man with diabetic nephropathy who became increasingly fatigued and started maintenance hemodialysis 6 months prior to admission. At 64 years, he underwent clipping of a right cerebellar artery aneurysm. In addition, a 1.8 cm aneurysm was found in the contralateral extracranial internal carotid artery. He also had an atrial septal defect and moderate aortic regurgitation and was receiving continuous positive airway pressure therapy for sleep apnoea syndrome.

Diagnosis:

He had aneurysms in the aortic arch (4.8 cm in diameter) and descending aorta (6 cm in diameter), which was located at T6–9. Preoperative 3-dimensional computed tomography showed that the (AKA) bifurcated at T10–11.

Interventions:

Considering the patient’s several comorbidities and frailty, we planned to perform 1-stage extended aortic arch repair using the FET procedure. However, we performed 2-stage aortic surgery to prevent spinal ischemia, anticipating substantial cardiac enlargement and blood pressure instability due to dialysis treatment. Aortic valve replacement, atrial septal defect patch closure, and aortic arch surgery were performed. A 7-cm elephant trunk was inserted in the descending aorta. Postoperatively, the patient continued rehabilitation until his blood pressure stabilized during dialysis therapy. At postoperative week 4, he underwent thoracic endovascular aortic repair for a descending aortic aneurysm.

Outcomes:

After surgery, his physical strength decreased; however, he recovered and was discharged 1 month later without any complications. One year after the second operation, he is living a healthy life.

Lessons:

Extensive aortic arch surgery using the FET procedure is effective for distal aortic arch and descending aortic aneurysms. Nevertheless, in cases in which the position of the AKA is close to the aortic aneurysm and blood pressure control is difficult, a 2-stage procedure and accurate positioning of thoracic endovascular aortic repair are both desirable.
A meta-analysis on efficacy and safety of rituximab for neuromyelitis optica spectrum disorders
Authors: Dong Gu-Yi , Meng Yan-Hong , Xiao Xiang-Jian
Published: September 2022

Background:

To assess the efficacy and safety of rituximab (RTX) in the treatment of neuromyelitis optica spectrum diseases (NMOSDs), and give a guideline on clinical medication

Methods:

The databases of Pubmed, Embase, Cochrane Library, CNKI, and Wan fang were systematically searched by computer, and the search period was from the establishment of the databases until January 2022. To collect the trials of RTX in the treatment of NMOSDs, two researchers completed literature screening, quality assessment, and data extraction independently. Statistical analysis was performed using Review Manager 5.3 and Stata 15.1 software.

Results:

There were 37 studies in the meta-analysis, including 5 randomized controlled trials (RCTs) and 32 observational studies. Meta-analysis results revealed that NMOSDs patients treated with RTX significantly reduced the annualized relapse rate (ARR) (weighted mean difference [WMD] = 1.45, 95% confidence interval [CI]: 1.24–1.66, P < .01) and the Expanded disability status scale (EDSS) scores (WMD = 1.34, 95%CI: 1.25–1.44, P < .01). RTX is more effective than azathioprine (AZA) in the treatment of NMOSDs (ARR: WMD = −0.54, 95% CI: −0.75 to −0.33; EDSS: WMD = −0.65, 95% CI: −0.83 to −0.48; P < .0001).There was no difference in ARR and EDSS scores between anti-aquapor in-4-antibody seropositive NMOSD and seronegative NMOSD patients treated with RTX (ARR: WMD = −0.01, 95% CI: −0.25 to 0.24, P = .96 > 0.05; EDSS: WMD = 0, 95% CI: −0.30 to 0.31, P = .99 > 0.05). In this study, 681 patients were recorded safety data of RTX therapy, 23% (156 patients) had adverse events, and 0.7% (5 patients) of NMOSDs discontinued due to severe adverse reactions.

Conclusions:

NMOSDs patients treated with RTX can significantly reduce the relapse frequency and EDSS scores, and also improve neurological dysfunction, besides the efficacy is better than azathioprine. RTX has a high incidence of adverse reactions, which are mild and with certain self limited, it should be cautious in clinical medication
Iodine-125 seed implantation combined chemotherapy for metastatic pancreatic adenocarcinoma with primary colon cancer: A case report
Authors: Song Yinghui , Qi Yuchen , Yu Zhangtao , Zhang Zhihua , Li Yuhang , Huang Junkai , Liu Sulai
Published: September 2022

Rationale:

Colon cancer has a distinct migration aptitude. However, pancreatic metastasis is rare and treatment of inoperable pancreatic cancers is seldom seen.

Patient concerns:

A 47-year-old woman presented 2-month history of abdominal pain and abdominal distention, with anal cessation of exhaust and defecation for 4 days. A colon cancer radical resection was performed when she diagnosed with colon cancer. After 26 months, the patient complained shoulder and back pain. Multiple intraperitoneal metastases and nonisolated pancreatic metastasis of colon cancer were diagnosed.

Diagnosis:

Metastatic pancreatic adenocarcinoma (MPA) with primary colon cancer.

Intervention:

Iodine-125 seed implantation combined chemotherapy.

Outcomes:

She remains free of cancer metastasis and recurrence, and has a good quality of life during the period.

Lessons subsections:

Iodine-125 seed implantation is an effective and safe strategy for unresectable metastatic pancreatic cancer. Iodine-125 seed implantation combined with chemotherapy improve survival for advanced pancreatic metastasis of colon cancer.
Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report
Authors: Artigues Serra Francisca , García-Gasalla Mercedes , Campins Antoni , González de Cabo Miguel , Morales Rafael , Peña Rebecca Rowena , Gallegos María Carmen , Riera Melchor
Published: September 2022

Rationale:

Since its first identification in the early 1990s, Mycobacterium genavense has been considered and opportunistic pathogen. It mainly causes gastrointestinal symptoms, but also disseminated infections in severely immunosuppressed patients. Sclerosing mesenteritis is a long-term complication with high morbidity and mortality. As it is a rare condition, there are no specific guidelines for its management. We report a challenging case of persistent M. genavense infection, and propose surgery as an alternative treatment strategy.

Patient concerns:

A 38-year-old Caucasian man presented to the emergency room with fever, abdominal pain, and night sweats for 3 months. HIV screening revealed a previously unknown HIV-1 infection, with a CD4 cell count of 216 cell/µL and viral load of 361.000 copies/mL at diagnosis. A body CT-scan showed mild splenomegaly as well as mesenteric and retroperitoneal enlarged lymph nodes. Fine needle aspiration revealed the presence of acid-fast bacilli, but mycobacterial cultures were negative. In the second sample, 16S RNA sequencing yielded a diagnosis of M. genavense infection. Despite 2 years of corticosteroids and antimycobacterial treatment excluding rifampicin due to a severe cutaneous reaction, there was no clinical improvement and an increase in the mesenteric lymph node size was observed, with a sclerosing transformation of the mesentery. A surgical approach was proposed to release small bowel loops and to remove fibrin. A second surgery was required due to an acute peritonitis ought to yeyunal segmental isquemia and perforation. Finally, the patient evolved favorably, and antimycobacterial drugs were suspended without relapse.

Lessons.

Despite a prolonged multidrug strategy, some patients develop persistent M. genavense infection. Once sclerosing mesenteritis is established, clinicians have few treatment options. Surgery should be considered in patients with sclerosing mesenteritis or bowel obstruction. The combination of medical and surgical treatment could be a potential cure for these patients.
Ten-year atherosclerotic cardiovascular disease risk prediction for postmenopausal women: Impacts of isolated postchallenge hyperglycemia
Authors: Wu Tsung-Hui , Lin Yi-Chun , Hwu Chii-Min
Published: September 2022

Isolated postchallenge hyperglycemia (IPH) is a type of diabetes mellitus defined as 2-h glucose ≥200 mg/dL but fasting glucose <126 mg/dL. The purpose of the study was to assess impacts of IPH on 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores in postmenopausal women. This study analyzed data from 428 postmenopausal women who underwent oral glucose tolerance test at a medical center. Ten-year ASCVD risk was evaluated by using Pooled Cohort Equations. Logistic regression analysis was performed to estimate odds ratios for having high 10-year ASCVD risk scores (≥5%) among these women. The subjects with IPH had higher systolic blood pressure and worse lipid profile than those without IPH. Ten-year ASCVD risk scores for postmenopausal women with IPH were calculated under 2 scenarios: the IPH women were considered non-diabetic, they were designated as patients with DM. The median ASCVD risk score of the participants with IPH increased significantly from 3.7% under scenario 1 to 7.1% under scenario 2. Approximately 20% women with IPH were re-categorized from risk category of <5% to ≥7.5% once they were identified as patients with DM (scenario 2). The results of logistic regression analyses showed that IPH was independently positively associated with 10-year ASCVD risk scores ≥5% under both scenarios. Postmenopausal women with IPH were characterized by unfavorable cardiovascular risk profile and high predicted 10-year ASCVD risk. Knowing the women’s hidden DM status would significantly alter their risk categorization.
Comparison of duplex ultrasound and hemodynamic assessment with computed tomography angiography in patients with arterial thoracic outlet syndrome
Authors: Altuwaijri Talal A.
Published: September 2022

Thoracic outlet syndrome (TOS) presents with a variety of neurovascular symptoms, and its diagnosis cannot be established purely on the basis of clinical assessments. Computed tomography angiography (CTA) is currently the most useful investigative modality for patients with suspected vascular TOS. However, CTA facilities are limited, and CTA itself is an expensive and a resource-intensive technique associated with risks such as radiation exposure and contrast toxicity. Therefore, a screening test to identify the need for CTA may facilitate clinical management of patients with suspected TOS. Data for patients with suspected arterial TOS who underwent duplex ultrasound with arterial hemodynamic assessment (HDA) (pulse-volume recording and Doppler arterial pressure measurement) at King Saud University Medical City Vascular Lab between 2009 and 2018 were collected. The sensitivity, specificity, positive and negative predictive values (NPV), and area under the curve for duplex ultrasound and arm arterial HDA with CTA were reviewed. The data for 49 patients (mean age, 31 ± 14 years) were reviewed, of which 71% were female. The sensitivity, specificity, positive predictive value, and NPV of duplex ultrasound were 86.7%, 49.3%, 26.5%, and 94.6%, respectively. For arm arterial HDA, these values were 73.3%, 78.9%, 42.3%, and 93.3%, respectively. The combination of arm arterial HDA with duplex ultrasound scores yielded sensitivity, specificity, positive predictive value, and NPV of 93.3%, 42.3%, 25.5%, and 96.8%, respectively. The combination of duplex ultrasound with arm arterial HDA showed higher sensitivity and NPV than either test alone. The specificity of arm arterial HDA was significantly higher than that of the other measurements. When suspected, arterial TOS could be ruled out using duplex ultrasound and arm arterial HDA. These 2 investigations may help determine the need for CTA.
Identification of prognosis-related hub genes of ovarian cancer through bioinformatics analyses and experimental verification
Authors: Yu Zhong , Ouyang Ling
Published: September 2022

Ovarian cancer (OC) is a lethal and highly prevalent disease in women worldwide. The disease is often diagnosed in late stages, which leads to its rapid progression and low survival rate. This study aims to identify new prognostic genes for OC. Based on 2 datasets from the National Center for Biotechnology Information Gene Expression Omnibus public database, we constructed 2 Weighted Gene Co-expression Network Analysis networks. Then, we selected and intersected 2 key modules to screen key genes. Enrichment analyses were performed, and a protein-protein interaction network was constructed. The cytoHubba plugin of Cytoscape and survival analysis were used to screen hub genes related to prognosis. The expression of hub genes was analyzed by GEPIA and verified by quantitative Real-Time PCR. Gene alteration frequency analysis, gene set variation analysis, immune infiltration analysis, drug sensitivity analysis, tumor mutation burden, and neoantigen analyses were conducted to determine the prognostic value and molecular mechanisms of the hub genes. In total, 214 key genes were selected from 2 Weighted Gene Co-expression Network Analysis networks, and 3 hub genes, namely ALDH1A2, CLDN4, and GPR37, were identified as prognostic candidates through cytoHubba and survival analysis. Three hub genes were significantly associated with overall survival of OC patients. GEPIA and quantitative Real-Time PCR indicated that ALDH1A2 expression was significantly downregulated, while expression of CLDN4 and GPR37 was upregulated in OC samples compared with normal samples. CIBERSORT showed that 3 hub genes were closely associated with the infiltrating immune cells. GDSC showed that hub genes expression influenced IC50 values of chemotherapeutic drugs. OC patients with high expression of ALDH1A2 and CLDN4 had lower TMB and low ALDH1A2 expression could produce a larger number of neoantigens. In conclusion, the 3 hub genes (ALDH1A2, CLDN4 and GPR37) identified through bioinformatics analyses in the present study may serve as OC prognosis biomarkers. The study findings offer valuable insights into OC progression and mechanisms.
Efficacy and safety of Chinese medicine combined with acupuncture in the treatment of chronic urticaria: A meta-analysis
Authors: Lu Zhenxiong , Zhou Qiujun , Chai Shiqian , Yang Huifeng , Wang Jinhui , Luo Hongbin , Cao Yi , Tao Maocan
Published: September 2022

Background:

Increasing studies have shown that Chinese medicine combined with acupuncture has a significant effect on chronic urticaria, which can treat both symptoms and root causes. This meta-analysis aims to compare the efficacy and safety differences between acupuncture combined with conventional Western medicine, so as to provide guidance for the clinical treatment of chronic urticaria.

Methods:

We searched Pubmed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM from the establishment of the database to August 2021. We included randomized controlled trial study that the experimental group was acupuncture combined with traditional Chinese medicine, while the control group was treated with conventional Western medicine. We excluded repeated publication, researches without full text, incomplete information, or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data.

Results:

The pooled results show that total effective rate of acupuncture combined with traditional Chinese medicine group was significantly higher than that in the conventional Western medicine group (ratio rate [RR] = 1.29, 95% confidence interval [CI]: 1.2–1.38). Additionally, the pooled results show that Urticaria Activity Score (standardized mean difference = –1.51, 95% CI: –2.24 to –0.78) and pruritus score (standardized mean difference = –1.09, 95% CI: –1.71 to –0.47) of acupuncture combined with traditional Chinese medicine group was significantly lower than that in conventional Western medicine group, while there is no significant difference in wheal score between acupuncture combined with traditional Chinese medicine group and conventional Western medicine group. Importantly, the pooled results show that recurrence rate (RR = 0.35, 95% CI: 0.19–0.64) and the incidence of adverse events (RR = 0.27, 95% CI: 0.10–0.75) of acupuncture combined with traditional Chinese medicine group were all significantly lower than that in conventional Western medicine group.

Conclusion:

Our research results found that traditional Chinese medicine combined with acupuncture has a more significant effect than conventional Western medicine and can significantly reduce the recurrence rate and the incidence of adverse reactions. The application of traditional Chinese medicine combined with acupuncture in the treatment of chronic urticaria should be further promoted.
Safety of Vitamin K in mechanical heart valve patients with supratherapeutic INR: A systematic review and meta-analysis
Authors: Sapapsap Bannawich , Srisawat Chansinee , Suthumpoung Pornsinee , luengrungkiat Onjira , Leelakanok Nattawut , Saokaew Surasak , Kanchanasurakit Sukrit
Published: September 2022

Background:

Patients who had mechanical heart valves and an international normalized ratio (INR) of >5.0 should be managed by temporary cessation of vitamin K antagonist. This study aimed to investigate the safety of low-dose vitamin K1 in patients with mechanical heart valves who have supratherapeutic INR.

Methods:

CINAHL, Cochran Library, Clinical trial.gov, OpenGrey, PubMed, ScienceDirect, and Scopus were systematically searched from the inception up to October 2021 without language restriction. Studies comparing the safety of low-dose vitamin K1 treatment in patients with placebo or other anticoagulant reversal agents were included. We used a random-effect model for the meta-analysis. Publication bias was determined by a funnel plot with subsequent Begg’s test and Egger’s test.

Results:

From 7529 retrieved studies, 3 randomized control trials were included in the meta-analysis. Pooled data demonstrated that low-dose vitamin K was not associated with thromboembolism rate (risk ratio [RR] = 0.94; 95% CI: 0.19–4.55) major bleeding rate (RR = 0.58; 95% CI: 0.07–4.82), and minor bleeding rate (RR = 0.60; 95% CI: 0.07–5.09). Subgroup and sensitivity analysis demonstrated the nonsignificant effect of low-dose vitamin K on the risk of thromboembolism. Publication bias was not apparent, according to Begg’s test and Egger’s test (P = .090 and 0.134, respectively).

Conclusion:

The current evidence does not support the role of low-dose vitamin K as a trigger of thromboembolism in supratherapeutic INR patients with mechanical heart valves. Nevertheless, more well-designed studies with larger sample sizes are required to justify this research question.