bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Cardiovascular Health and Adverse Childbirth Outcomes in the United States
Authors: Muchira James M. , Heelan-Fancher Lisa , Hayman Laura L.
Published: April 2021

Background

Cardiovascular-related adverse childbirth outcomes have been increasing in the United States, with widening racial and ethnic disparities.

Objective

We examined the association between maternal cardiovascular health (CVH) and childbirth outcomes among US births.

Methods

We analyzed data from the Pregnancy Risk Assessment Monitoring System. Ideal CVH was defined as a composite of 4 cardiovascular disease (CVD) risk factors: absence of a medical diagnosis of diabetes, hypertension, history of cigarette smoking before or during pregnancy, and a pre-pregnancy body mass index of 18.5 to 24.9 kg/m2. Childbirth outcomes examined were preterm birth, low birthweight, and mode of birth. Survey logistic regression was used for multivariate analyses.

Results

A total of 34 918 women were included in our study, and most (61%) had more than 1 CVD risk factor. Clustering of CVD risk factors was more likely among women with an annual income of less than $40 000 and not college educated and found among non-Hispanic Black, Hispanic, and American Indian/Alaska Natives (P < .001). The odds of an adverse childbirth outcome increased with each additional CVD risk factor. Hypertension was highest among non-Hispanic Black women (20%) and the strongest predictor of having a low-birth-weight infant (odds ratio [OR], 3.16; 95% confidence interval [CI], 2.86–3.48), preterm birth (OR, 2.72; 95% CI, 2.40–3.07), and cesarean birth (OR, 1.68; 95% CI, 1.52–1.87).

Conclusion

Clustering of maternal CVD risk factors was significantly associated with adverse childbirth outcomes. Unfavorable CVH and its association with adverse childbirth outcomes were most common in women of color, calling for special attention to this group.
Effects of Ayahuasca on the Recognition of Facial Expressions of Emotions in Naive Healthy Volunteers
Authors: Rocha Juliana Mendes , Rossi Giordano Novak , de Lima Osório Flávia , Bouso José Carlos , de Oliveira Silveira Gabriela , Yonamine Mauricio , Campos Alline Cristina , Bertozi Giuliana , Cecílio Hallak Jaime E. , dos Santos Rafael G.
Published: April 2021

Background

The recognition of emotions in facial expressions (REFE) is a core aspect of social cognition. Previous studies with the serotonergic hallucinogens lysergic acid diethylamide and psilocybin showed that these drugs reduced the recognition of negative (fear) faces in healthy volunteers. This trial assessed the acute and prolonged effects of a single dose of ayahuasca on the REFE.

Methods

Twenty-two healthy volunteers participated in a pilot, proof-of-concept, randomized trial. Study variables included a REFE task performed before and 4 hours after drug intake, subjective effects (self-reports/observer impressions), tolerability measures (cardiovascular measures, self-reports), and brain-derived neurotrophic factor plasma levels. The REFE task was applied again 1, 7, 14, and 21 days and 3 months after drug intake. Stability of ayahuasca alkaloids during the study was also assessed (room temperature, 18 months).

Findings

Compared with placebo, ayahuasca did not modify the REFE. No significant effects were observed on cardiovascular measures and brain-derived neurotrophic factor levels. Volunteers reported visual effects, tranquility/relaxation, and well-being, with few reports of transient anxiety/confusion. Ayahuasca was well tolerated, producing mainly nausea, gastrointestinal discomfort, and vomiting. A significant time-dependent deterioration of alkaloids was observed, especially for dimethyltryptamine.

Conclusions

Absence of significant effects on the REFE task could be due to lack of effects of ayahuasca (at the doses used), alkaloid degradation, learning effects, and the high educational level of the sample. Further trials with different samples are needed to better understand the effects of ayahuasca and other serotonergic hallucinogens on the REFE. Future trials should improve methods to guarantee the stability of ayahuasca alkaloids.
Awareness of Forensic Cases Among Nurses: A Descriptive, Cross-Sectional Study
Authors: Bektaş Gülfer , Pakiş Işıl
Published: April 2021

Purpose

This study reports the knowledge, experience, and attitudes of nurses toward forensic cases in Turkey; critically evaluates the appropriateness of current practices in the collection and preservation of evidence; and assesses nurses' level of awareness on the law enforcement perspective of forensic cases. The study, thereby, seeks to offer solutions to some practical difficulties faced by nurses in clinical practice in Turkey.

Methods

The study involved 178 nurses of 202 employed in three healthcare centers operated by the same private healthcare group located in Istanbul, Turkey. The primary method of data collection was a questionnaire composed of three sections. The first section recorded data concerning the participants' age, gender, number of years spent in the profession, number of years spent in current workplace, department in which they worked, and their job title. The second section sought to assess the participants' academic background and, specifically, the extent of their educational training on forensic cases at the undergraduate and graduate levels. Finally, the third section aimed to assess the participants' knowledge of and approach toward the management of forensic cases in real-life time setting by collecting data on their previous experience with forensic cases.

Results

Of 178 nurses, 139 (78.1%) were female and 39 (21.9%) were male. The mean age was 28.6 years, ranging from 18 to 51 years. The participants expressed that they experienced difficulties in medicolegal procedures (21.9%), evidence collection (14.0%), history taking and preparation of the patient (10.1%), forensic case reporting (10.1%), registry (9.0%), and physical examination (7.9%). The level of knowledge of the collection of forensic evidence and the protection of wet evidence was statistically higher among the participants who previously received training on the collection, preservation, and transfer of forensic evidence versus those who were not previously trained (p < 0.001 for both).

Conclusion

Our study results highlight the need for medicolegal regulations and legislation allowing for the creation of specific positions for forensic nurses in Turkey. We also concluded that these nurses should be trained and equipped with necessary knowledge and skills in forensic nursing.
Evidence Collection and Analysis for Touch Deoxyribonucleic Acid in Groping and Sexual Assault Cases
Authors: Valentine Julie L. , Presler-Jur Paige , Mills Heather , Miles Suzanne
Published: April 2021

Historically, evidence collection in sexual assault cases focused on obtaining foreign contributor bodily fluids through swab collection. With improvements in deoxyribonucleic acid (DNA) analysis methods, DNA profiles can be developed from touch DNA and applied to sexual assault cases. Following a literature review on factors affecting touch DNA transfer, a groping case study with innovative evidence collection is presented to support the expansion of touch DNA evidence collection in sexual assault cases. The groping case led to the development of a statewide sexual assault touch DNA form to guide evidence collection. DNA findings from additional groping sexual assault cases are reported to further show and justify the importance of evidence collection in groping cases. Implications on multidisciplinary practices are summarized to promote evidence collection and analysis in groping sexual assault cases. As forensic nurses are educated to accurately collect DNA evidence and provide trauma-informed, patient-centered care, they are best suited to provide nursing care for patients who have experienced groping sexual assaults. Optimal DNA findings in groping and sexual assault cases are best achieved through development of strong multidisciplinary, collaborative relationships between forensic nurses and forensic scientists.
Circulating miR-449a predicts survival outcome for colorectal cancer following curative resection
Authors: Fu Dengke , Chen Yang , Xu Dongkui
Published: April 2021

Previous studies showed that microRNA (miR)-449a may function as a tumor suppressor. However, the expression pattern and value of circulating miR-449a in colorectal cancer (CRC) remain unclear. Therefore, the purpose of this study was to measure circulating miR-449a level of CRC patients and evaluate its value for predicting prognosis.

Plasma samples of 343 consecutive CRC patients and 162 healthy controls were obtained. Circulating miR-449a levels were measured by using real-time quantitative reverse transcription polymerase chain reactions. All enrolled patients were followed up in a regular interval after surgery. The clinical data and survival outcome of all 343 patients were collected. The correlation between circulating miR-449a level and survival outcomes was analyzed by univariate and multivariate analysis.

Circulating miR-449a level in CRC patients was significantly decreased (P < .05) comparing with healthy controls. Low miR-449a was significantly associated with CEA and CA19-9 level (both P < .05). Furthermore, patients with a decreased miR-449a level had a lower 5-years overall survival (OS) rate than those with a high miR-449a (67.4% vs 76.9%, P = .03). Low circulating miR-449a level also been demonstrated as an independent risk factor for CRC in multivariate COX analysis (HR, 2.56; 95%CI: 1.15–8.63; P < .05).

Circulating miR-449a was significantly decreased in CRC patients and closely related to poor prognosis, suggesting that miR-449a might can be used as a useful diagnostic and prognostic marker for CRC.
Myocardial strain features by 2D-STE during the course of fulminant myocarditis
Authors: Zuo Houjuan , Li Haojie , Li Rui , Ma Fei , Jiang Jiangang , Li Chenze , Xia Liming , Wang Hong , Wang Dao Wen
Published: April 2021

Myocardial strain analysis by 2D speckle tracking echocardiography could determine the left ventricular function. Our purpose is to investigate the global longitudinal strain (GLS) changes during the course of fulminant myocarditis (FM) and evaluate their correlation with cardiac magnetic resonance (CMR).

Patients with clinical diagnosis of FM from June 30, 2017 to June 30, 2019 were screened prospectively. 18 survived patients (mean age 34 ± 18 years) who had two scans of transthoracic echocardiography and underwent CMR were included.

All patients had severely impaired left ventricular ejection fraction and GLS value at admission that improved significantly before discharge. The patients in the healed stage revealed elevated global native T1 and T2 relaxation time and extracellular volume fraction as well, which were 1408.3 ± 88.3ms, 46.56 ± 5.23ms, and 0.35 ± 0.09, respectively. GLS from the second transthoracic echocardiography in the healed stage correlated significantly with global native T1 relaxation time (r =-0.574, P = .013) and with extracellular volume fraction (r = -0.582, P = .011), but not global native T2 relaxation time (r = -0.31, P = .211) and not with late gadolinium enhancement mass (r = 0.084, P = .743). In comparison, GLS at admission were not correlated with CMR parameters of fibrosis and oedema in the healed stage.

GLS by 2D-STE may emerge as a new tool to monitor inflammatory myocardial injuries during the course of FM. FM in the acute healed stage has the presence of both chronic fibrosis and oedema which are correlated with GLS, but GLS at admission can’t predict the early recovery of myocardial inflammation.
Disseminated ovarian granulosa cell tumor after laparoscopic surgery
Authors: Cui Man-Hua , Zhang Xi-Wen , Zhao Li-Ping , Liu Shu-Yan , Jia Yan
Published: April 2021

Rationale:

Granulosa cell tumors (GCT) have an incidence of 0.6 to 0.8/100,000. Short-term relapsed ovarian GCT is extremely rare. Herein, this report aims to present 2 rare cases of disseminated ovarian GCT and analyze the causes of recurrence.

Patient concerns:

The 2 patients presented with abdominal pain.

Diagnosis:

Both the patients were diagnosed with relapsed ovarian GCT (IIIc stage) in the adult type.

Interventions:

The 2 patients had a medical history of surgery for ovarian GCT by using laparoscopic with power morcellators (LPM). They experienced relapsed ovarian GCT postoperatively. Subsequently, they received a repeated operation through a laparotomy approach. Numerous malignant metastasis neoplasms were detected at the port-sites. Then, tumor resection was performed.

Outcomes:

The postoperative pathologies of both case 1 and case 2 reported ovarian GCT (IIIc stage) in adult type. The 2 patients presented disease-free survival for more than 33 months follow-up period.

Lessons:

The application of LPM may be a risk factor of disseminated ovarian GCT. However, laparoscopic surgery is still an optimal treatment strategy for ovarian tumors. Besides, gynecologists should comply with the tumor-free principle during surgery.
Clinical, laboratory, and imaging features of pediatric COVID-19
Authors: Qi Kai , Zeng Weibiao , Ye Miao , Zheng Li , Song Chao , Hu Sheng , Duan Chuanhui , Wei Yiping , Peng Jinhua , Zhang Wenxiong , Xu Jianjun
Published: April 2021

Pediatric cases of coronavirus disease 2019 (COVID-19) have been reported. This meta-analysis was aimed at describing the clinical, laboratory, and imaging characteristics of children with COVID-19 based on published data of pediatric COVID-19 cases.

Search of PubMed, Embase, Web of Sciences, Science Direct, and Google Scholar for articles published until December 14, 2020, that described the clinical, laboratory, and imaging features of children with COVID-19. Data were extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled results.

Clinical data from 2874 children with COVID-19 from 37 articles were finally included for quantitative analyses. Fever (48.5%, 95% CI: 41.4%–55.6%) and cough (40.6%, 95% CI: 33.9%–47.5%) were the most common symptoms; asymptomatic infection and severe cases, respectively, accounted for 27.7% (95% CI: 19.7%–36.4%) patients and 1.1% of the 1933 patients included. Laboratory tests showed 5.5% (95% CI: 2.8%–8.9%) of the patients had lymphopenia. The pooled prevalence of leukopenia was 7.3% (95% CI: 3.4%–12.2%), and the C-reactive protein level was high in 14.0% (95% CI: 6.8%–22.8%). Chest computed tomography showed unilateral and bilateral lesions, and ground-glass opacity in 29.4% (95% CI: 24.8%–34.3%) and 24.7% (95% CI: 18.2%–31.6%), and 32.9% (95% CI: 25.3%–40.9%), respectively, and normal in approximately 36.0% (95% CI: 27.7%–44.7%).

We found that children with COVID-19 had relatively mild disease, with quite a lot of asymptomatic infections and low rate of severe illness. Data from more regions are needed to determine the prevention and treatment strategies for children with COVID-19.
Thymic adenocarcinoma accompanied by type A thymoma and pulmonary minimally invasive adenocarcinoma and harboring distinct gene alterations
Authors: Zheng Yi-Wen , Bai Lin-Lin , Jiang Gui-Yang , Lin Xu-Yong , Liu Yang , Xu Hong-Tao
Published: April 2021

Rationale:

Thymic adenocarcinoma is an extremely rare thymic carcinoma. The exact genetic alteration associated with thymic adenocarcinoma is unclear. Here, we report a case of thymic adenocarcinoma accompanied by type A thymoma and pulmonary minimally invasive adenocarcinoma (MIA).

Patient concerns:

A 53-year-old woman presented with multiple nodules in the mediastinum and lung. Thoracic computed tomography revealed nodules in the anterior superior mediastinum and anterior mediastinum near the right pericardium and ground-glass opacity (GGO) in the right superior lobe of the lung.

Diagnosis:

The tumor in the anterior superior mediastinum was diagnosed as primary thymic papillary adenocarcinoma. The tumor in the anterior mediastinum near the right pericardium was diagnosed as type A thymoma. The GGO of the right superior lobe of the lung was diagnosed as a MIA.

Intervention:

The patient underwent thoracoscopic mediastinal tumor resection and partial lobectomy in our hospital.

Outcomes:

The postoperative course was uneventful. The patient is alive and free of the disease for 22 months after diagnosis.

Lessons:

Thyroid transcription factor 1 (TTF-1) was positive in this case of thymic adenocarcinoma, which indicated that a thymic adenocarcinoma with TTF-1-positive may not necessarily be a metastasis of lung or thyroid adenocarcinoma. The positive staining of CD5 and CD117 can help us to confirm the thymic origin. Molecular genetic analysis indicated that these tumors harbored different mutations. The thymic adenocarcinoma and type A thymoma both had the mutation of KMT2A, but the mutation sites were different. KMT2A mutation may be a common genetic change in thymic tumorigenesis. The genetic alterations disclosed in this study will help expand the understanding of thymic tumors.
Nonconvulsive status epilepticus manifesting as rapidly progressive dementia and infarction in the splenium of the corpus callosum
Authors: Zhao Qian , Sun Lichao , Hu Boqi , Lin Weihong
Published: April 2021

Rationale:

Nonconvulsive status epilepticus (NCSE) is a heterogeneous disease with multiple subtypes. NCSE poses great diagnostic and therapeutic challenges due to the lack of typical symptoms. Here, we report a case of NCSE manifesting as rapidly progressive dementia (RPD) and infarction in the splenium of the corpus callosum. Additionally, the relevant literature was reviewed.

Patient concerns:

A 63-year-old man presented with RPD. Electroencephalogram (EEG) revealed NCSE, and brain magnetic resonance imaging (MRI) showed an isolated infarction in the splenium of the corpus callosum. Mini-mental state examination showed moderate cognitive impairment (14/30 points).

Diagnosis:

A diagnosis of NCSE with RPD and infarction in the splenium of the corpus callosum was made.

Interventions:

The patient was treated with intravenous diazepam (10 mg), oral levetiracetam (1.0g twice daily), oral sodium valproate (0.2g twice daily), and intramuscular phenobarbital sodium (0.2g once daily).

Outcomes:

After the treatment, the symptoms were improved. The patient could answer questions. Repeated EEG showed that the background a rhythm was slightly overdeveloped, and no clinical or electrical seizures were observed. After discharge, the patient was treated with oral levetiracetam (1.0g twice daily) and oral sodium valproate (0.2g twice daily) for 6 months. At the last follow-up, the patient had clear consciousness, sensitive response, and fluent answering ability. Repeated mini-mental state examination showed that his cognitive function was significantly improved (28/30 points); nevertheless, the lesion in the splenium of corpus callosum remained unchanged on MRI.

Lessons:

NCSE manifesting as RPD and infarction in the splenium of the corpus callosum is extremely rare. Epileptic events and focal infarction are usually overlooked in patients with dementia, and the diagnostic value of MRI and EEG should be highlighted
Effects of perinatal HIV-infection on the cortical thickness and subcortical gray matter volumes in young adulthood
Authors: Ruiz-Saez Beatriz , García Manuela Martín-Bejarano , de Aragon Ana Martinez , Gil-Correa Mario , Melero Helena , Malpica Norberto Antonio , de Ory Santiago Jimenez , Zamora Berta , Guillen Sara , Rojo Pablo , Falcon-Neyra Lola , Alvarez Alberto , Fernandez Pilar , Lorente-Jareño María Luisa , Ramos Jose Tomas , Sainz Talía , Velo Carlos , Navarro Maria Luisa , Gonzalez-Tomé Maria Isabel
Published: April 2021

Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance.

A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented.

Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19–23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P > .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: −0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = −0.00000008, P = .045, respectively).

PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.
Association between red blood cell distribution width and in-hospital mortality in acute myocardial infarction
Authors: Huang Sulan , Zhou Quan , Guo Ning , Zhang Zhixiang , Luo Li , Luo Yanlan , Qin Zuoan , Ge Liangqing
Published: April 2021

Previous studies have shown an independent association between increased red cell distribution width (RDW) and mortality after acute myocardial infarction (AMI). However, evidence regarding the predictive significance of repeated measures of RDW in patients with AMI remains scarce. We aimed to investigate the association between the dynamic profile of RDW and in-hospital mortality in patients with AMI.

This was a cross-sectional study. We extracted clinical data from the Medical Information Mart for Intensive Care IIIV1.4 database. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was in-hospital mortality. Cox proportional hazards models were used to evaluate the prognostic values of basic RDW, and the Kaplan–Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. The repeated-measures data were compared using a generalized additive mixed model.

In total, 3101eligible patients were included. In multivariate analysis, adjusted for age, sex, and ethnicity, RDW was a significant risk predictor of in-hospital mortality. Furthermore, after adjusting for more confounding factors, RDW remained a significant predictor of in-hospital mortality (tertile 3 vs tertile 1: hazard ratio 2.3; 95% confidence interval 1.39–4.01; P for trend <.05). The Kaplan–Meier curve for tertiles of RDW indicated that survival rates were highest when RDW was ≤13.2% and lowest when RDW was ≥14.2% after adjustment for age, sex, and ethnicity. During the intensive care unit stay, the RDW of nonsurvivors progressively increased until death occurred.

Our findings showed that a higher RDW was associated with an increased risk of in-hospital mortality in patients with AMI.
The efficacy of amniotic membrane-mediated sequential double-barrier therapy for the treatment of postoperative intrauterine adhesions
Authors: Wu Chaoying , Dong Yishan , Li Yong , Liu Hefang
Published: April 2021

To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.

A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.

The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).

Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.
Correlation analysis of IGF-1, ZAG, nesfatin-1, HbA1c levels, and type 2 diabetes mellitus complicated with hypothyroidism
Authors: He Shuangling , He Ying , Jin Fenghua , Liu Yanjie
Published: April 2021

To analyze the correlation between IGF-1, ZAG, nesfatin-1, HbA1c levels, and type 2 diabetes mellitus (T2DM) complicated with hypothyroidism.

Fifty-five patients with type-2 diabetes who were admitted to our hospital from August 2018 to February 2020 were selected as the control group, and 55 patients with type 2 diabetes combined with hypothyroidism who were admitted to the hospital at the same period were selected as the combined group, and 56 patients who came to our hospital for physical examination at the same period were selected as the healthy group. The general clinical data and relevant laboratory indexes of all patients in the three groups were collected and statistically analyzed. Besides, the correlation between IGF-1, ZAG, nesfatin-1, HbA1c levels, and T2DM complicated with hypothyroidism was analyzed.

Levels of FPG, FINS, TC, TG, LDL, 2hPBG, TPOAb, TgAb, and HOMA-IR in the diabetes group and combined group were all significantly higher than those in the healthy group, while HDL and T4 levels in the diabetes group and combined group were lower than those in the healthy group (P < .05). The levels of FPG, FINS, TC, TG, LDL, 2hPBG, TPOAb, and TgAb in the combined group were significantly higher than those in the diabetes group (P < .05), and the levels of HDL and T4 were lower than those in the diabetes group. In addition, the IGF-1 level was positively correlated with ZAG, nesfatin-1, and HbA1c levels in the combined group (P < .05), and IGF-1 (OR: 0.964, 95% CI: 0.943–0.983, P = .001), ZAG (OR: 1.298, 95% CI: 1.121–1.401, P = .005), nesfatin-1 (OR: 0.876, 95% CI: 0.751–0.901, P = .002), and HbA1c (OR: 1.321, 95% CI: 1.121–1.401, P = .012) were independent risk factors for T2DM complicated with hypothyroidism.

Regular detection of IGF-1, ZAG, nesfatin-1, and HbA1c levels are of great value for the diagnosis and treatment of patients with T2DM complicated with hypothyroidism.
High pretreatment D-dimer level is an independent unfavorable prognostic factor of small cell lung cancer
Authors: Deng Han-Yu , Ma Xing-Sheng , Zhou Jie , Wang Ru-Lan , Jiang Rui , Qiu Xiao-Ming
Published: April 2021

Background:

High pretreatment level of D-dimer in small cell lung cancer (SCLC) is commonly encountered, but the impact of high pretreatment D-dimer level on the prognosis of SCLC patients remains undetermined. Therefore, we conducted this meta-analysis focusing specifically on the prognostic value of high pretreatment D-dimer level in SCLC patients comprehensively.

Methods:

We searched systematically in PubMed, Embase, and Web of Science for relevant studies published before January 28, 2019. Outcomes including 1-year overall survival (OS), progression-free survival (PFS) rates, and hazard ratios (HRs) of OS and PFS from multivariate analysis were extracted and analyzed.

Results:

A total of 5 cohort studies consisting of 813 SCLC patients (473 patients with high pretreatment level of D-dimer and 340 with normal level of D-dimer) were finally included for meta-analysis. We found that patients with high pretreatment level of D-dimer had significantly shorter 1-year OS (47.6% vs 79.9%; fixed effects: risk ratio [RR] = 2.506; 95% confidence interval [CI] = [1.948, 3.224]; P < .001) and PFS (15.8% vs 34.0%; random effects: RR = 1.294; 95% CI = [1.060, 1.579]; P = .011) rates than those with normal level of D-dimer. Moreover, high pretreatment D-dimer level was further proved to remain as an unfavorable predictor of OS (fixed effects: HR = 1.865; 95% CI = [1.469, 2.367]; P < .001; I
2 = 7.6%) and PFS (fixed effects: HR = 1.513; 95% CI = [1.183, 1.936]; P = .001; I
2 = 0.0%) in patients with SCLC.

Conclusion:

High pretreatment level of D-dimer was found to be an independent unfavorable prognostic factor in SCLC patients. However, more studies with sufficient adjustment for confounding factors are encouraged to confirm our conclusions.
Ventralis oralis anterior (Voa) deep brain stimulation plus Gamma Knife thalamotomy in an elderly patient with essential tremor
Authors: Oh Byeong Ho , Park Young Seok
Published: April 2021

Rationale:

Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous.

Patient concerns:

We report a case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET.

Diagnosis:

An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS.

Intervention:

We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim.

Outcomes:

After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient's hand tremor successfully improved without any complications.

Lessons:

Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first case report using salvage Voa as the only target for ET.
The association between interleukin-8 gene-251 A/T polymorphism and sepsis
Authors: Zhao Shiqiao , Gong Junzuo , Yin Songlin , Li Xiaofeng , Zhao Shuangquan , Mou Tianyi , Luo Shu
Published: April 2021

Background:

Emerging evidence has indicated that interleukin-8 (IL-8) gene-251A/T polymorphism may affect individual susceptibility to sepsis. However, the results of published studies are inconclusive. The aim of this meta-analysis was to elucidate the association between this polymorphism and the risk and mortality of sepsis.

Methods:

Relevant publications were searched from PubMed, EmBase, and Web of Science databases up to January 31, 2021, with studies only in English. The reference lists of the retrieved studies were investigated as well. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated to figure out the relationship between IL-8-251 A/T polymorphisms and the risk and mortality of sepsis. All of the data were analyzed with Stata 16.0.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This meta-analysis will summarize the relationship between IL-8-251 A/T polymorphism and the risk and mortality of sepsis.
A systematic review and meta-analysis on the regulation of programmed cell death-1 on T-cells in type 2 diabetes
Authors: Nyambuya Tawanda Maurice , Dludla Phiwayinkosi Vusi , Mxinwa Vuyolwethu , Nkambule Bongani Brian
Published: April 2021

Background:

To assess T-cell exhaustion mediated by programmed cell death 1 (PD-1) pathway in patients living with type 2 diabetes (T2D).

Methods:

MEDLINE and ProQuest electronic databases were searched for eligible studies from inception up to February 2020. The risk of bias and the quality of evidence were independently assessed by two reviewers using the modified Newcastle-Ottawa Scale adapted for cross-sectional studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, respectively. The random effects model was used to calculate effect estimates.

Results:

We identified 5 studies involving 380 participants which met the inclusion criteria. The pooled estimates showed elevated T helper cell exhaustion in patients with T2D in comparison to controls (mean difference [MD]: 2.57% [95% confidence interval [CI]: –3.84, 8.97]; I
2 = 100%, P < .00001). Likewise, T2D patients had increased levels of cytotoxic T-cells exhaustion (MD: 3.09% [95% CI: –12.96, 19.14]; I
2 = 100%, P < .00001). Although the upregulation of PD-1 on T-cells did not affect glucose metabolism-related profiles, it was associated with inflammation and the development of cardiovascular disease.

Conclusion:

In patients living with T2D, immune dysfunction is at least in part due to T-cell exhaustion mediated by the upregulation of PD-1 expression. Therefore, the use of immune checkpoint inhibitors as a therapeutic strategy may be beneficial in restoring immune function in patients with T2D.
Indwelling catheter increases the risk of urinary tract infection in total knee arthroplasty
Authors: Shuai Mingying , Li Yueping
Published: April 2021

Background:

The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA).

Methods:

PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time.

Results:

A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004).

Conclusion:

The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA.

Level of Evidence:

Level I, therapeutic study.
Effects of trimetazidine in combination with bisoprolol in patients with chronic heart failure and concomitant chronic obstructive pulmonary disease
Authors: Zhang Xiaoyan , Ma Shujuan , Fu Baocai
Published: April 2021

Background:

To the best of our knowledge, there is no study that has conducted a review investigating the clinical efficacy and safety of bisoprolol combined with trimetazidine on chronic heart failure (CHF) patients with chronic obstructive pulmonary disease (COPD). Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the effectiveness and safety of bisoprolol combined with trimetazidine on CHF patients with COPD.

Methods:

Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in April 2021 by 2 independent reviewers. For search on PubMed, the following search terms will be used: “trimetazidine, bisoprolol, chronic heart failure, chronic obstructive pulmonary disease.” In order to achieve a consistency of extracted items, the data extractors will extract data from a sample of eligible studies. The outcomes include all-cause mortality and hospitalization for cardiac or/and respiratory causes; left ventricular structure and function; and functional scores. Review Manager software (v 5.4; Cochrane Collaboration) will be used for the meta-analysis. Two independent reviewers will assess the risk of bias of the included studies at study level. Any disagreements will be discussed and resolved in discussion with a third reviewer.

Results:

The results of our review will be reported strictly following the PRISMA criteria.

Conclusions:

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

OSF registration number:

10.17605/OSF.IO/ZWPRB.
Critical preparedness and operational response actions directed for the acute and post-acute COVID-19 pandemic in Brazil: the experience of a nationwide outpatient healthcare group
Authors: Torres Ulysses S. , Kerbauy Daniella M.B. , Barrancos Janaína T.G. , D’Ippolito Giuseppe , Lázari Carolina S. , Granato Celso Francisco H. , Rizzatti Edgar Gil , Meirelles Gustavo S.P.
Published: April 2021

While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.
Prophylactically injection of Nicorandil to reduce no-reflow phenomenon during PCI in acute STEMI patients
Authors: An Su , Huang Huopeng , Wang Huaying , Jiang Yunlu
Published: April 2021

Introduction:

An acute ST-elevation myocardial infarction (STEMI) is a very serious type of heart attack and a profoundly life-threatening medical emergency, and percutaneous coronary intervention (PCI) is the preferred strategy. However, in patients undergoing primary PCI, 30% to 40% may suffer the no-reflow phenomenon (NRP), and it could expand the myocardial infarction area and accompanied with high rehospitalization rate and fatality rate. In this study, we try to conduct a double blinded, randomized, placebo-controlled trial to observe whether the prophylactically intracoronary administration of Nicorandil could reduce the occurrence of NRP in STEMI patients undergoing PCI.

Methods:

Simple randomization in a 1:1 ratio will be made in blocks of variable size according to a random numbers generated by Excel 2010 to divide the patients to treatment group (Nicorandil) and control group (Saline). The outcomes are the occurrence of NRP, levels of interleukin-6 and HS-CRP, cTnT, and CK-MB before, and every 4 hours following PCI, and major adverse cardiovascular events at day 30. SPSS 23.0 (IBM, Chicago, IL) will be used, and P-value < .05 will be considered statistically significant.

Conclusions:

The findings will determine the efficacy of prophylactically intracoronary administration of Nicorandil to reduce the occurrence of NRP during PCI in acute STEMI patients.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/QPF3V
Serious bronchospasm induced by cisatracurium besylate
Authors: Wang Ning , Zhang Yaozhong , Hu Yu , Yang Qiyao , Su Zhenbo
Published: April 2021

Rationale:

Cis-atracurium as an intermediate-acting non-depolarizing neuromuscular blocker is widely used clinically with less causing cyclic fluctuations and less histamine release. As the use rate increases, allergic reactions and anaphylactoid reactions caused by cis-atracurium increase.

Patient concerns:

A 23-year-old woman underwent laparoscopic bariatric surgery. Airway spasm occurred after anesthesia induction and the operation was suspended. After adjustment, the anesthesia was performed with the same anesthetic scheme again. After induction, skin flushing and airway resistance increased, then the symptoms were relieved. When the cis-atracurium was given again, the symptoms of airway spasm reappeared immediately, and after communicating with the family, the operation was successfully completed with rocuronium.

Diagnoses:

Serious bronchospasm induced by cisatracurium besylate.

Interventions:

The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and aminophylline 250 mg, methylprednisolone 80 mg were given intravenously.

Outcomes:

There was no any obvious discomfort in the patient's self-report during the next day's visit. The patient was discharged 7 days later. No abnormalities were observed during following 4 weeks.

Lessons:

Although the anaphylactoid reactions caused by cis-atracurium are rare, the bronchospasm and anaphylactic shock caused by it greatly increase the risk of anesthesia, which should be taken seriously by clinicians. Increased vigilance in diagnosis, and treatment are essential to prevent aggravation and further complication.
A case report of acquired methemoglobinemia rescued by veno-venous extracorporeal membrane oxygenation
Authors: Lien Yu-Hsuan , Lin You-Cian , Chen Robert Jeenchen
Published: April 2021

Rationale:

Severe methemoglobinemia (Met-Hb) is rare. The delayed diagnosis and treatment often cause further damage. The management of cellular hypoxemia is challenging and the use of extra-corporeal membrane oxygenation (ECMO) has never been reported.

Patient concerns:

The young patient, healthy with unremarkable past medical history, was sent to emergency room with out-of-hospital circulatory arrest (OHCA) and severe generalized cyanosis. His family reported he ingested sodium nitrite accidentally.

Diagnoses:

After successful resuscitation and return of spontaneous circulation (ROSC), the paradoxically normal arterial blood gas (ABG) with the unusual brownish blood led to the suspicion of Met-Hb. The lab test confirmed it and showed a very high level of 80%.

Interventions:

Because of recovered and normal cardiac function, we placed veno-venous extracorporeal membrane oxygenation (VV-ECMO) for tissue hypoxemia in addition to exchange transfusion, vitamin C, and methylene blue.

Outcomes:

Met-Hb blood level dropped rapidly. After vigorous rehabilitation for weeks, the patient was able to be discharged home without major neurological sequela.

Lessons:

VV-ECMO can hyper-oxygenate the hypoxemic tissue regardless the etiology and minimize hypoxemia-reperfusion injury while awaiting the definite diagnosis and therapy.
Safety and efficacy of angiotensin-converting enzyme inhibitors in aortic stenosis
Authors: Xu Chengsheng , Xu Juanjuan , Yang Juan
Published: April 2021

Background:

Although there are many studies showing potential benefit in aortic stenosis (AS) patients taking angiotensin-converting enzyme inhibitors (ACEI), but these studies are subject to significant selection and other biases, making the results challenging to interpret. Furthermore, the evidence on the use of ACEI in AS patients has not been reviewed systematically; we thus conducted this protocol assess the clinical effectiveness and safety of ACEI for patients with AS.

Methods:

The following search terms will be used in PUBMED, Scopus, EMBASE, and Cochrane Library databases on May, 2021, as the search algorithm: (angiotensin-converting enzyme inhibitors) OR (ACEI) AND (aortic stenosis) OR (AS). Two searchers will independently draft and carry out the search strategy, and the third member will further complete it. The studies on cohort study focusing on assessing the efficacy of ACEI on AS patients will be included in our meta-analysis. At least one of the following outcomes should have been measured: left ventricular mass, exercise tolerance, B-type natriuretic peptide, adverse event, functional outcomes, and aortic valve area. All outcomes are pooled on random-effect model. A P value of <.05 is considered to be statistically significant.

Results:

The results of this research will be delivered in a peer-reviewed journal.

Conclusion:

Depending on the previous studies, we assumed that ACEI could possibly improve the clinical symptoms and outcomes of symptomatic AS.

Systematic review registration number:

10.17605/OSF.IO/G9KPT.
Identification and analysis of key genes associated with acute myocardial infarction by integrated bioinformatics methods
Authors: Guo Siyu , Wu Jiarui , Zhou Wei , Liu Xinkui , Liu Yingying , Zhang Jingyuan , Jia Shanshan , Li Jialin , Wang Haojia
Published: April 2021

Background:

Acute myocardial infarction (AMI) is a common disease leading threat to human health around the world. Here we aimed to explore new biomarkers and potential therapeutic targets in AMI through adopting integrated bioinformatics tools.

Methods:

The gene expression Omnibus (GEO) database was used to obtain genes data of AMI and no-AMI whole blood. Furthermore, differentially expressed genes (DEGs) were screened using the “Limma” package in R 3.6.1 software. Functional and pathway enrichment analyses of DEGs were performed via “Bioconductor” and “GOplot” package in R 3.6.1 software. In order to screen hub DEGs, the STRING version 11.0 database, Cytoscape and molecular complex detection (MCODE) were applied. Correlation among the hub DEGs was evaluated using Pearson's correlation analysis.

Results:

By performing DEGs analysis, 289 upregulated and 62 downregulated DEGs were successfully identified from GSE66360, respectively. And they were mainly enriched in the terms of neutrophil activation, immune response, cytokine, nuclear factor kappa-B (NF-κB) signaling pathway, IL-17 signaling pathway, and tumor necrosis factor (TNF) signaling pathway. Based on the data of protein–protein interaction (PPI), the top 10 hub genes were ranked, including interleukin-8 (CXCL8), TNF, N-formyl peptide receptor 2 (FPR2), growth-regulated alpha protein (CXCL1), transcription factor AP-1 (JUN), interleukin-1 beta (IL1B), platelet basic protein (PPBP), matrix metalloproteinase-9 (MMP9), toll-like receptor 2 (TLR2), and high affinity immunoglobulin epsilon receptor subunit gamma (FCER1G). What's more, the results of correlation analysis demonstrated that there was positive correlation between the 10 hub DEGs.

Conclusion:

Ten DEGs were identified as potential candidate diagnostic biomarkers for patients with AMI in present study. However, further experiments are needed to confirm the functional pathways and hub genes associated with AMI.