bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative study regarding menstrual hygiene in a rural community of Haryana, India
Authors: Parija Pragyan Paramita , Sharma Nitika , Salve Harshal R , Kumar Rakesh , Yadav Kapil , Mandal Suprakash
Published: October 2022

Introduction

Adolescent girls face challenges in menstrual hygiene in routine patterns which impacts their education and health. A qualitative study was undertaken to assess the knowledge and practices regarding menstruation in a rural community of Haryana and to identify the barriers to menstrual hygiene.

Methodology

The study was conducted in the month of September 2019 among various stakeholders i.e. adolescent females, adolescent males, Accredited Social Health Activist (ASHA) workers, Anganwadi workers, school teachers and Medical Officers. The stakeholders were mapped with the help of a Multi-Purpose Health Worker and ASHA of the village. Interview guides for focus group discussion (FGD) and in-depth interview (IDI) were prepared from previous literature to understand menstrual health management among the stakeholders.

Results

After IDI and FGD, we found that there is a barrier to accessibility of regular sanitary pads, a lack of education on menstrual hygiene among adolescent girls. School absenteeism was a concern due to the unavailability of mechanisms for the disposal of sanitary pads in school and poor maintenance of toilets.

Conclusion

Proper implementation of the Adolescent Reproductive Sexual Health program and Menstrual health education can improve the use and reduce stigma and ignorance. Free uninterrupted supply of sanitary pads through school and Anganwadi will help improving accessibility and separate toilets for girls would lead to a reduction in absenteeism.
Fast-forwarding evolution—Accelerated adaptation in a proofreading-deficient hypermutator herpesvirus
Authors: Xing Na , Höfler Thomas , Hearn Cari J , Nascimento Mariana , Camps Paradell Georgina , McMahon Dino P , Kunec Dusan , Osterrieder Nikolaus , Cheng Hans H , Trimpert Jakob
Published: October 2022

Evolution relies on the availability of genetic diversity for fitness-based selection. However, most deoxyribonucleic acid (DNA) viruses employ DNA polymerases (Pol) capable of exonucleolytic proofreading to limit mutation rates during DNA replication. The relative genetic stability produced by high-fidelity genome replication can make studying DNA virus adaptation and evolution an intensive endeavor, especially in slowly replicating viruses. Here, we present a proofreading-impaired Pol mutant (Y547S) of Marek’s disease virus that exhibits a hypermutator phenotype while maintaining unimpaired growth in vitro and wild-type (WT)-like pathogenicity in vivo. At the same time, mutation frequencies observed in Y547S virus populations are 2–5-fold higher compared to the parental WT virus. We find that Y547S adapts faster to growth in originally non-permissive cells, evades pressure conferred by antiviral inhibitors more efficiently, and is more easily attenuated by serial passage in cultured cells compared to WT. Our results suggest that hypermutator viruses can serve as a tool to accelerate evolutionary processes and help identify key genetic changes required for adaptation to novel host cells and resistance to antiviral therapy. Similarly, the rapid attenuation achieved through adaptation of hypermutators to growth in cell culture enables identification of genetic changes underlying attenuation and virulence, knowledge that could practically exploited, e.g. in the rational design of vaccines.
Is Standing Function Improved After Orthopaedic Surgery in Children With Cerebral Palsy at GMFCS Levels III/IV?
Authors: Lennon Nancy , Church Chris , Chua Theresa , Salazar-Torres Jose J. , Henley John , Gillooly Elizabeth , Shrader M. Wade , Kalisperis Faithe , Miller Freeman , Howard Jason J.
Published: October 2022

Background:

Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels III/IV are at risk for losses in standing function during adolescence and transition to adulthood. Multilevel surgery (MLS) is an effective treatment to improve gait, but its effects on standing function are not well documented. The objectives of our study were to describe standing function in children with CP classified as GMFCS levels III/IV and evaluate change after MLS.

Methods:

This retrospective study included children with CP (GMFCS III/IV) ages 6 to 20 years who underwent instrumented gait analysis. A subset who underwent MLS were evaluated for change. Primary outcome measures were Gross Motor Function Measure dimension D, gait velocity, functional mobility scale, and the Pediatric Outcomes Data Collection Instrument (PODCI). Additional impairment level measures included foot pressure, knee extension during stance phase of gait, and knee extension passive range of motion.

Results:

Four hundred thirty-seven instrumented gait analysis sessions from 321 children with CP (ages 13.7±4.8 y; GMFCS III-81%/IV-19%) were included. The GMFCS III group had higher Gross Motor Function Measure dimension D, gait velocity, PODCI scores, and better knee extension compared with the GMFCS IV group (P<0.05); 94 MLS were evaluated for postoperative change 15.3±4.2 months after MLS. Children at GMFCS level III had improved PODCI scores (P<0.05), better knee extension passive range of motion (P<0.01), and improved coronal plane foot pressure (P<0.05) post MLS. Maximum knee extension during stance and heel impulse improved significantly in both groups (P<0.01).

Conclusions:

Standing function of children with CP at GMFCS IV was significantly more limited than at GMFCS III. After MLS, both groups (III/IV) showed improvement in impairment level outcomes (knee extension and foot position), whereas only those functioning at GMFCS III had improvement in activity/participation outcomes according to the PODCI. For children with CP at GMFCS levels IV, MLS may improve standing function, but appropriate goals related to assisted standing and measurement protocols sensitive to limited functional mobility should be adopted.

Level of Evidence:

Level III—retrospective comparative study.
A Case Series With Acquired Dermal Melanocytosis: A Retrospective Study From 2001 to 2018
Authors: Hsiao Pa-Fan , Chou Wayne , Wu Yu-Hung
Published: October 2022

Acquired dermal melanocytosis (ADM) is a pigmented lesion caused by melanocytes in the dermis, and it is most often observed on the face of young and middle-aged Asian women. ADM development may be associated with melanin synthesis alterations, but little evidence of its molecular and histological alteration has yet been reported. This study aimed to evaluate ADM in different body locations using different immunohistochemical and chemical staining techniques. This retrospective case series includes consecutive patients confirmed as ADM by biopsy between 2001 and 2018. Patient data and archival images were used to determine the pattern and duration of skin lesions, as confirmed by data analysis of immunohistopathological staining of skin biopsy specimens. A total of 22 ADM patients were included with mean age at diagnosis of 47 years, and 63.6% were female. The most common site was limbs (36.4%), followed by face (27.3%), trunk (22.7%), and scalp (13.6%). Melanin levels were highest in the face and upper extremities and lowest in the trunk. All participants had perivascular distribution of dermal melanocytes, particularly on the face and limbs. The perineural distribution of dermal melanocytes was observed in the lower limbs, with prominent inflammation and fibrosis on the scalp. Dermal melanocytes expressed most markers recognizing melanocytes except for CD117. Analysis of this ADM case series has confirmed that melanin is activated by dermal melanocytes that may aggregate along blood vessels. CD117 may be a useful biomarker by which to identify the migration of epidermal melanocytes.
Presence of the partner in the operating room during emergency caesarean section
Authors: Nedergaard Helene K. , Balaganeshan Thanikaivashan , Weitling Eva E. , Petersen Henriette S. , Brøchner Anne C.
Published: October 2022

BACKGROUND

Emergency caesarean sections are often very urgent, with limited time for informing and guiding parents. Is it preferable to leave the partner outside of the operating room, or let the partner accompany the mother?

OBJECTIVE

This review aimed to provide an overview of the available evidence regarding the presence of the partner in the operating room during emergency caesarean sections.

DESIGN

Scoping review.

DATA SOURCES

A systematic literature search was performed in PubMed, Embase, Cinahl and the Cochrane Library.

ELIGIBILITY CRITERIA

All published literature reporting on emergency caesarean sections in regional or general anaesthesia with the partner present in the operating room were eligible, no matter the design.

RESULTS

Twenty-four titles, published between 1984 and 2020, were included; 15 contained original clinical findings and 9 were letters/debates. Quality of evidence was assessed using the Mixed Methods Appraisal Tool and found to be very low/low (17 studies), moderate (6) or good (1). Studies originated from Europe (16 studies), USA/Canada (4), South America (2), Asia (1) and Africa (1). Content data were thematically summarised and were overall either in favour or against having the partner present. Staff seemed reluctant to let partners be present for caesarean sections under general anaesthesia; mothers and partners preferred the partners’ presence. Under regional anaesthesia, parents also wished for the partners’ presence and described the caesarean section under regional anaesthesia as a predominantly positive experience. Most staff had a favourable attitude towards letting the partner be present for caesarean sections under regional anaesthesia.

CONCLUSION

Limited evidence exists regarding the presence of the partner during emergency caesarean sections, but is of low quality. Most parents prefer having their partner present. Staff can be reluctant, especially when general anaesthesia is used.
CHOROIDAL NEVUS ASSOCIATED WITH VITELLIFORM DEPOSITION IN A PATIENT WITH AUTOSOMAL DOMINANT BEST DYSTROPHY
Authors: Adams Olufemi E. , Siddiqui Yousuf , Simmons Michael A. , Tang Peter H. , Koozekanani Dara D.
Published: October 2022

Background/Purpose:

To describe the clinical, optical coherence tomography (OCT), fundus autofluorescence and ultrasound findings of a patient with a choroidal nevus actively exuding vitelliform material in the setting of autosomal dominant Best dystrophy (BD).

Methods:

The patient's clinical course was followed over time with ophthalmic examinations and multimodal imaging.

Results:

A 71-year-old male patient with BD was referred for evaluation of a choroidal nevus in the right eye. Dilated fundoscopic examination showed a small pigmented choroidal nevus in the temporal periphery. Over a 3-year period, the nevus developed progressive deposition of vitelliform material along its inferior border. Meanwhile, OCT and fundus photography showed only slight growth. Ultrasound showed no change in height; basal measurements were confounded by the increased vitelliform deposits. Genetic testing confirmed a heterozygous mutation in theBEST1gene and electrophysiology was consistent with BD.

Conclusions:

Dysfunction of the retinal pigment epithelium associated with BD may cause novel presentations of other conditions such as choroidal nevi. The implication for malignant transformation of a choroidal nevus associated with vitelliform deposit accumulation in this context is unknown.
Fluorescein-Assisted Microsurgical Resection of Vestibular Schwannoma: A Prospective Feasibility Study
Authors: Chan Stephen A. , Macielak Robert J. , Tuchscherer Amy M. , Neff Brian A. , Driscoll Colin L.W. , Peris-Celda Maria , Van Gompel Jamie J. , Link Michael J. , Carlson Matthew L.
Published: October 2022

Objective

To evaluate the optimal dose and timing of administration of sodium fluorescein (SF) for selective fluorescence of sporadic vestibular schwannoma (VS) during microsurgery with the YELLOW 560-nm microscope filter (YE560) and to characterize the potential benefit of this fluorescence as determined by intraoperative surgeon assessment.

Study Design

Prospective cohort study.

Setting

Tertiary referral center.

Patients

Adult patients undergoing VS microsurgery.

Interventions

Intraoperative intravenous administration of SF and visualization with the YE560.

Main Outcome Measures

Time to differential fluorescence, duration of fluorescence, correlation of fluorescence of VS with electrostimulation and white light microscopy visual assessment, and likelihood of surgeons to use SF with the YE560 in future cases.

Results

Novel use of SF and YE560 during microsurgery achieved selective fluorescence of VS with capabilities to differentiate nerve fascicles and tumor approximately 30 minutes after administration. Nuances of SF administration and timing are discussed. Seventy-five percent of surgeons observed an excellent correlation of selective fluorescence with white light microscopy. Representative images and cases are presented.

Conclusions

SF and YE560 may be used in VS microsurgery to visually differentiate VS from surrounding nerves. Potential benefits include enhanced visualization of the tumor–nerve interface for tumor dissection and detection of any residual disease, such as in the fundus after hearing preservation microsurgery.
Anticoagulant and antiplatelet activity of aqueous extracts of Citrus sinensis and Lippia alba: interactions and potential for the development of antithrombotics
Authors: Leite Paula Mendonça , Miranda Ana Paula Nader , Gomes Izabella , Rodrigues Maria Luiza , Amorim Juliana Mendes , de Lima Gilberto Augusto Teixeira Dalboni , Duarte Rita Carolina Figueiredo , Fuly André Lopes , Faraco André Augusto Gomes , das Graças Carvalho Maria , Castilho Rachel Oliveira
Published: October 2022

Citrus sinensis and Lippia alba are herbal medicines widely used in the form of tea (infusion, decoction), which ethanolic extracts have already shown great anticoagulant activity in vitro. For this reason, they seem to be excellent candidates for the development of new antithrombotics and also have the potential to interact with them.

The aim of this study was to evaluate the activity of aqueous extracts in blood coagulation and platelet aggregation, in addition to analysing the micromolecular composition of these species.

Thrombin generation test (TGT) by the Calibrated Automated Thrombogram method and Platelet Aggregation Test by turbidimetry were performed to evaluate the biological activities, while the chemical composition was qualitatively evaluated using high-performance liquid chromatography. Aqueous extracts were elaborated according to the folk use.

All extracts were effective in reducing thrombin formation in TGT. Infusion of L. alba and infusion and decoction of C. sinensis at a concentration of 0.6 mg/ml significantly reduced platelet aggregation induced by ADP, and only the decoction of L. alba at the same concentration was able to significantly reduce collagen-induced platelet aggregation. The presence of phenylpropanoids and flavonoids in C. sinensis and L. alba extracts was verified. Furthermore, hesperidin was identified in C. sinensis through coinjection.

C. sinensis and L. alba are rich in phenolics and demonstrated an in-vitro effect on important processes of haemostasis (blood coagulation, platelet agreggation), corroborating the potential of C. sinensis and L. alba for the development of antithrombotics and interact with them.
Characterization of antibody clones that bind exclusively to insoluble fibrin
Authors: Fuchigami Hirobumi , Matsumura Yasuhiro
Published: October 2022

Previously, we established an antibody, termed 102-10, which recognizes insoluble fibrin exclusively, unlike the previously established anti-insoluble fibrin antibodies that also cross-reacted with fibrinogen. We established that the epitope of this antibody is on the β chain that lines an indented structure that becomes exposed only when insoluble fibrin is formed. The amino acid sequence of the epitope is completely conserved from mouse to humans. This study attempted to determine the most suitable insoluble fibrin clone for future diagnostic and therapeutic development. Binding kinetics and properties of antibodies were evaluated by the surface plasmon resonance analysis (SPR) and ELISA among 1101, 99, 443, and 102-10. Immunohistochemical staining for mouse and human pancreatic cancer tissues were also performed. For frozen sections, visually appropriate staining results were observed at an antibody concentration of 1–10 μg/ml, while for paraffin sections, 10 μg/ml was required. From immunohistochemistry and ELISA analyses, clone 99 and clone 1101 showed almost no nonspecific binding in normal pancreatic tissues. Hybridoma production for 1101 yielded more antibodies than that of 99 and demonstrated good long-term stability. It was, therefore, concluded that clone 1101 would be useful for future clinical development as well as basic research.
Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis
Authors: Thandra Abhishek , Pajjuru Venkat , Jhand Aravdeep , Ponamgi Shiva , Ismayl Mahmoud , Torres Rosa Cruz , Sharma Arunima , Narmi Ann , Agarwal Himanshu , Kanmanthareddy Arun
Published: October 2022

Background

Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA.

Methods

PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random-effects model.

Results

Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37–3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11–1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06–14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23–3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30–3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both.

Conclusion

In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.
Effect of transradial catheterization and nifedipine on flow- and nitroglycerin-mediated dilations of distal and proximal radial artery
Authors: Bi Xile , Guo Qianghua , Jia Hongdan , Song Tingting , Feng Jianshuang , Li Min , Wang Qingsheng
Published: October 2022

Objective

Radial artery (RA) dysfunction after transradial access intervention is not limited to the distal portion but can also occur in the proximal portion of RA. The aim of the present study was to assess the effect of sublingual nifedipine administrated prior to puncture on the endothelial function of distal and proximal RA.

Methods

Eighty-nine patients who underwent coronary angiography (CAG) were randomly assigned to the nifedipine group (n = 45) or control group (n = 44). The flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of distal and proximal RA were measured at baseline, 24 h, and 48 h after transradial angiography.

Results

Compared with the control group, the nifedipine group only limited the reduction of FMD in the distal RA at 24 and 48 h [6.52 ± 1.40% (24 h) vs. 5.85 ± 1.38% (24 h), P = 0.03; 7.41 ± 1.30% (48 h) vs. 6.65 ± 1.25% (48 h), P = 0.006], whereas FMD alterations in the proximal RA were not restored by nifedipine. Both groups were still lower than baseline values (11.66 ± 2.35% and 11.24 ± 2.22%). We observed similar effects of nifedipine on the NMD of the distal RA.

Conclusion

Although transradial angiography-induced dysfunction was reported in both distal and proximal RA, nifedipine could help restore the distal endothelial function of the cannulated RA.
Platelet-rich plasma for the treatment of chronic rectal ulcer: A case report
Authors: Liu Gengjun , Li Ying , Li Yaxin , Wang Licun , Li Ping , Liu Zheng , Liu Jiao , Ge Dongmei , Zhao Gang , Wang Haiyan
Published: October 2022

Rationale:

Rectum ulcer is a disease of the digestive system, the main symptoms of which includes bloody diarrhea, abdominal pain, hematochezia, etc. At present, drug therapy and surgery are the most common treatments. Platelet-rich plasma (PRP) contains high concentrations of platelets and has been used to promote wound healing. However, the utilization of PRP in rectal ulcers has rarely been reported.

Patient concerns:

The patient had reported a complaint of blood dripping from the stool for more than 4 months. She had a history of surgery for rectal cancer with postoperative chemotherapy and radiotherapy 19 years prior. Mesalazine suppository was given to her for about 4 months, and glutamine capsules for 2 months, but the rectal ulcer remained unhealed.

Diagnosis:

A rectal ulcer was observed on colonoscopy, and the biopsy result was tubular adenoma.

Interventions:

Autologous PRP treatment was performed for the patient under an anorectal scope together with basic supportive care.

Outcomes:

The ulcer nearly healed within 9 days after twice PRP treatments.

Lessons:

PRP treatment may bring about novel treatment options for rectal ulcers.
Vancomycin dosing required to achieve a therapeutic level in children post-surgical correction of congenital heart disease
Authors: Alakeel Yousif S. , Alanazi Ghadah A. , Alawbathani Bushra S. , Alshutwi Kadi I. , Alahmed Yazeed S.
Published: October 2022

The vancomycin dosing range for safe and effective treatment remains uncertain for children who had corrective surgery for a congenital heart disease (CHD). We aimed to determine the vancomycin dosing requirements for this subgroup of patients.

This prospective cohort study included children younger than 14 years old with CHD who received intravenous vancomycin for at least 3 days at the Pediatric Cardiology section of King Abdulaziz Medical City, Riyadh.

In total, 140 pediatric patients with CHD were included with a median age of 0.57 years (interquartile range 0.21–2.2). The mean vancomycin total daily dose (TDD), 37.71 ± 6.8 mg/kg/day, was required to achieve a therapeutic trough concentration of 7–20 mg/L. The patient’s age group and the care setting were significant predictors of the vancomycin dosing needs. Neonates required significantly lower doses of 34 ± 6.03 mg/kg/day (P = .002), and young children higher doses of 43.97 ± 9.4 mg/kg/day (P = .003). The dosage requirements were independent of the type of cardiac lesion, cardiopulmonary surgery exposure, sex, and BMI percentile. However, the patients in the pediatric cardiac ward required higher doses of vancomycin 41.08 ± 7.06 mg/kg/day (P = .039). After the treatment, 11 (8.5%) patients had an elevated Scr, and 3 (2.3%) patients developed AKI; however, none of the patients’ sociodemographic factors or clinical variables, or vancomycin therapy characteristics was significantly associated with the renal dysfunction.

Overall, the vancomycin TDD requirements are lower in pediatric post-cardiac surgery compared to non-cardiac patients and are modulated by several factors.
PD-1 and CTLA-4 inhibitors in combination vs. alone for the treatment of advanced melanoma: A systematic review and meta-analysis
Authors: He Runzhi , Zhao Xiaoling , Liu Jianmin , Zhou Yajing , Zhang Xiaochong , Cheng Fang
Published: October 2022

Background:

Metastatic melanoma treatment has drastically changed during the past decade with the advent of immunotherapy. We conducted a meta-analysis, to assess PD-1 and CTLA-4 inhibitors in combination vs. alone for the treatment of advanced melanoma.

Methods:

The EMBASE, Medline via PubMed, Scopus, Cochrane Central, and Web of Science databases were searched. The records retrieved were screened for eligibility. Odds ratio (OR) was applied to compare dichotomous variables. All the results were reported with 95% confidence intervals (CI). Mantel–Haenszel method was used to estimate pooled OR and 95% confidence intervals for dichotomous data.

Results:

We retrieved 3092 citations of which we included 3 randomized controlled trials and 2 retrospective, cohort studies. The pooled OR was 2.144 (95% CI: 1.650–2.786, I2
= 80.38% P = .000) for overall response and 2.117 (95% CI: 1.578–2.841, I2
= 70.17% P = .000) for the complete response (CR). Subgroup analysis in nivolumab category showed that the pooled OR was 1.766 (95% CI: 1.324–2.355, I
2 = 0.0% P = .000) for the overall response and was 1.284 (95% CI: 0.889–1.855, I
2 = 0.0% P = .182) for the CR and in the ipilimumab category the pooled OR was 5.440 (95% CI: 2.896–10.220, I2
= 70.89% P = .001) for the overall response and was 5.169 (95% CI: 3.163–8.446, I2
= 0.0% P = .000) for the CR. The incidence of any treatment-related adverse events was significantly higher in the combination group than that of the nivolumab monotherapy 4.044 (95% CI: 1.740–9.403, I2
= 91.64% P = .001) or the ipilimumab monotherapy 2.465 (95% CI: 0.839–7.236, I2
= 93.02 % P = .101).

Conclusion:

Combination therapy with ipilimumab plus nivolumab is a promising strategy in the treatment of patients with advanced melanoma with superior overall and complete responses over either monotherapies.
Clinical investigation of a unique type of hypothalamic adrenal insufficiency
Authors: Takeshita Kaori , Abe Ichiro , Nagata Mai , Ochi Kentaro , Senda Yuki , Koga Midori , Ohe Kenji , Abe Makiko , Kudo Tadachika , Kobayashi Kunihisa
Published: October 2022

Hypothalamic adrenal insufficiency (AI) is a rare but distinct type of AI. The leading cause of hypothalamic AI is a secondary side-effect of exogenous steroid intake, particularly in large amounts and/or long-term periods. The next cause would be the effect of the tumor in the hypothalamic lesions. We show here 9 cases of hypothalamic AI without any disorder on imagings and a history of steroid administration. All patients had general fatigue; 7 patients (77.8%) had a history of hypoglycemia; 5 patients (55.6%) had a history of hypotension. None of the patients had hyponatremia, hyperkalemia, or eosinophilia. Their morning plasma adrenocorticotropic hormone (ACTH) value was low at 8.5 ± 4.2 pg/mL, and serum cortisol value was low at 4.5 ± 1.3 µg/dL. All patients demonstrated normal responses during the corticotropin-releasing hormone loading (CRH) test but inadequate responses during the insulin tolerance test (ITT). After hydrocortisone replacement therapy, their morning plasma ACTH and serum cortisol values were significantly recovered (P < .05). Moreover, more than half of the patients were fine after discontinuing hydrocortisone replacement therapy. These results indicate that this unique type of hypothalamic AI has a curable clinical course making hydrocortisone replacement therapy a novel therapeutic option.
Effect of the nurse-led program on blood glucose control and microalbuminuria development in type 2 diabetic populations
Authors: Li Ling , Wang Suping , Huang Guoding , You Jingyan
Published: October 2022

Current study was to evaluate whether the nurse-led program can improve glycated hemoglobin (HbA1c) control and reduce the incidence of microalbuminuria in type 2 diabetic mellitus (DM2) populations. A total of 150 DM2 subjects were randomly assigned to the usual-care group and nurse-led program group. Study endpoints included the HbA1c value, the percentage of subjects with HbA1c < 7.0%, the incidence of microalbuminuria, and the rate of adhering to antidiabetic drug at 6 months’ follow-up. At baseline, there was no difference in fasting plasma glucose, HbA1c, proportion of subjects with HbA1c < 7.0%, the use of antidiabetic drug, and urinary albumin-creatinine ratio between these two groups. After 6 months’ follow-up, the mean fasting plasma glucose and HbA1c were lower in the nurse-led program group, as was the proportion of subjects with HbA1c < 7.0%. The median urinary albumin-creatinine ratio and rate of incident microalbuminuria were also lower in the nurse-led program. The nurse-led program was associated with higher odds of achieving HbA1c < 7.0% and a lower incidence of microalbuminuria. After adjusted for covariates, the nurse-led program was still associated with 32% higher odds of achieving HbA1c < 7.0% and 11% lower incidence of microalbuminuria. These benefits were consistent by sex and age, while greater in those with obesity or hypertension (P interaction < .05). The nurse-led program is beneficial for blood glucose control and prevention of microalbuminuria.
Identification of potential hub genes of gastric cancer
Authors: Zhou Xu-Dong , Qu Ya-Wei , Wang Li , Jia Fu-Hua , Chen Peng , Wang Yin-Pu , Liu Hai-Feng
Published: October 2022

Background:

Gastric cancer (GC) is a malignant tumor originated from gastric mucosa epithelium. It is the third leading cause of cancer mortality in China. The early symptoms are not obvious. When it is discovered, it has developed to the advanced stage, and the prognosis is poor. In order to screen for potential genes for GC development, this study obtained GSE118916 and GSE109476 from the gene expression omnibus (GEO) database for bioinformatics analysis.

Methods:

First, GEO2R was used to identify differentially expressed genes (DEG) and the functional annotation of DEGs was performed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. The Search Tool for the Retrieval of Interacting Genes (STRING) tool was used to construct protein-protein interaction (PPI) network and the most important modules and hub genes were mined. Real time quantitative polymerase chain reaction assay was performed to verify the expression level of hub genes.

Results:

A total of 139 DEGs were identified. The functional changes of DEGs are mainly concentrated in the cytoskeleton, extracellular matrix and collagen synthesis. Eleven genes were identified as core genes. Bioinformatics analysis shows that the core genes are mainly enriched in many processes related to cell adhesion and collagen.

Conclusion:

In summary, the DEGs and hub genes found in this study may be potential diagnostic and therapeutic targets.
The radiological prognostic factors of transcatheter arterial chemoembolization to hepatocellular carcinoma
Authors: Lee Shou-Wu , Yen Chieh-Ling , Cheng Yu-Chi , Shun Yang Sheng , Lee Teng-Yu
Published: October 2022

Transcatheter arterial chemoembolization (TACE) is the recommended treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the HCC radiological characteristics associated with prognosis of patients with intermediate stage HCC receiving TACE. Patients with HCC BCLC stage B from January 2005 to December 2009 were collected. According to mRECIST criteria, patients with complete response and partial response were assigned to the objective response (OR) group, while those with stable disease and progressive disease were assigned to the nonobjective response (non-OR) group. Among a total of 128 enrolled patients, there were 66 (51.6%) and 62 (48.4%) patients in the OR group and non-OR group, respectively. The clinical parameters in the two groups were similar, although HCC size was smaller in the OR group. Logistic analysis found combined radiological characteristics including complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush were significant correlated with achievement of OR (odds ratio 2.46, 95% CI 1.08–5.61, P = .032). However, no radiological characteristics had significant strength to predict overall survival. Patients with OR after TACE had significantly longer survival time than those with non-OR. Combined characteristics of complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush had a positive impact on OR in TACE. In patients receiving TACE, those who achieved OR had a better overall survival.
Study on the protective mechanism of dexmedetomidine on the liver of perioperative diabetic patients: A randomized controlled trial
Authors: Zeng Lin , Liu Juan , Zhang Tianyao , Liu Yusong , Liao Lumiu , Chen Xuelian , Dong Shuhua
Published: October 2022

Background:

Although several studies have reported that dexmedetomidine is a highly selective α2-adrenergic receptor agonist that protects liver function in perioperative patients by inhibiting oxidative stress (OS) and inflammatory response, patients with type 2 diabetes mellitus (T2DM) have not been included in the previous studies. The purpose of this study was to investigate the effects of perioperative low-dose dexmedetomidine on perioperative liver function in T2DM patients.

Methods:

This was a single-center, placebo-controlled randomized trial. Fifty-four T2DM patients scheduled for debridement of lower extremity ulcers were included in this study and randomly divided into 2 groups (n = 27 per group): the dexmedetomidine group (DEX group) and the control group (CON group). Continuous intravenous infusion of dexmedetomidine (DEX group) or normal saline (CON group) was administered from the completion of monitoring to the end of surgery. All participants received femoral and sciatic nerve block with 0.33% ropivacaine. The main result was the activity of liver enzymes (AST, ALT) reflecting liver function. The secondary results included variables reflecting blood glucose (Glu), blood lipids (TG, HDL, LDL, total cholesterol), biomarkers of OS (MDA, SOD), and systemic inflammatory response (TNF-α, IL-6).

Results:

Compared with CON group, DEX group exhibited a reduction in hemodynamic parameters, Glu, systemic inflammatory response, and liver injury indicators. OS response MDA activity was lower in DEX group than in CON group, while SOD was higher than that in CON group. The variables reflecting lipid metabolism function showed no differences between the groups.

Conclusion subsections:

Dexmedetomidine administered perioperatively can reduce Glu levels and protect the liver by attenuating OS injury and inflammatory response in T2DM patients without any potential risk.
Acupuncture for dyspnea and breathing physiology in chronic respiratory diseases: A protocol of a systematic review and meta-analysis of randomized controlled trials
Authors: Xiong Chan , Li Yu , Li Chen-Yi , Liu Ye-Fang , Wei Hua , Fu Juan-Juan
Published: October 2022

Background:

Dyspnea is one of the most common symptoms of chronic respiratory disease (CRD) and is closely related to increased functional disability and mortality, resulting in substantial adverse outcomes on patients and imposing great social and economic burden. Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating COPD and lung cancer, little is known about its effects on dyspnea relief in patients with CRD. The present study aimed to use a systematic review approach to evaluate the effectiveness and safety of acupuncture in the treatment of dyspnea in patients with CRD.

Methods:

We will search the following 9 databases from inception to June 30, 2022, PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, WANFANG Database, Chinses Scientific and Technological Periodical Database, and Chinese Biomedical Database, and the Cochrane Library Database. Clinical randomized controlled trials in English or Chinese that evaluate invasive acupuncture versus control group in treatment of CRD with dyspnea will be included. The primary outcome will be dyspnea scores, breathing physiological function, and the secondary outcomes include exercise tolerance by six-minute walk distance quality of life, quality of life and adverse events. Two reviewers will independently conduct study selection, data extraction and quality assessment. The Review Manager software will be used for meta-analysis. This protocol will be carried out in accordance with the PRISMA-P guidance.

Conclusion:

This systematic review and meta-analysis will provide the evidence of whether acupuncture is an effective and safe intervention for CRD with dyspnea. The results will be disseminated through peer-reviewed publication.
Network pharmacology study on the potential effect mechanism of Chuanzhi Tongluo Capsule in the treatment of cerebral infarction
Authors: Ma Shan , Fan Wenhui , Zhang Jianxin
Published: October 2022

Background:

Chuanxiong Tongluo capsules have been widely used to treat recovered stroke and cerebral infarction, but their specific therapeutic mechanism is not well understood.

Methods:

This study aims to investigate the mechanism of action for Chuanzhi Tongluo capsule on cerebral infarction based on a network pharmacology approach. The TCMSP platform collected the chemical composition of Chuanzhi Tongluo capsules. Its potential targets were predicted by Swiss target prediction and standardized using the Uniprot database for gene normalization. Meanwhile, the OMIM, Genecards, and TTD databases were used to obtain the targets related to cerebral infarction. The standard targets of Chuanzhi Tongluo capsule and cerebral infarction were uploaded to the STRING database to construct protein–protein interaction networks. Topological methods analyzed the key targets and components in the drug-component-disease-target network. Gene ontology function and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of the shared targets were performed using the DAVID database.

Results:

A total of 105 active ingredients and 427 targets were associated with Chuanzhi Tongluo capsule, and there were 3055 targets related to cerebral infarction disease and 240 common targets between the two keywords. The key targets included INS, ALB, IL-6, VEGFA, TNF, and TP53. The conduction pathways involved include the calcium signaling pathway, cAMP signaling pathway, cGMP-PKG signaling pathway, and TNF signaling pathway.

Conclusion:

The active ingredients in Chuanzhi Tongluo capsule may participate in the therapeutic process of cerebral infarction by regulating the calcium, cAMP, cGMP-PKG, and TNF signaling pathway through critical targets such as INS, ALB, IL-6, VEGFA, TNF, and TP53.
Development of a values-based decision aid to determine discharge destination: Case reports of older stroke survivors and their families
Authors: Aoki Yoriko , Nakayama Kazuhiro
Published: October 2022

Background:

Older adults affected by stroke must face a difficult choice between receiving post-discharge care at home or in a facility. This study aimed to develop a decision aid (DA) to help older adults and their families choose the place of post-discharge care based on their values.

Methods:

Values and data for designing the DA were obtained through interviews with older stroke patients and their families, a questionnaire survey of various health professionals, and a review of patients’ medical records. Next, a prototypic DA was prepared and tested for comprehensibility and usability using the 12-item International Patient Decision Aid Standards instrument.

Results:

The DA was developed based on the following 6 values that were common among older stroke patients and their families: “activities of daily living,” “services and fees,” “emergencies,” “family support,” “environment,” and “home renovation.” The prototype met the criteria in the comprehensibility and usability tests.

Conclusion:

Older stroke patients can use the DA to think through the evidence-based information matching their own values to make a more satisfactory decision. The effectiveness of this DA should further be investigated in clinical settings.
Advocating for in-center hemodialysis patients via anonymous survey
Authors: Rajasekaran Arun , Prakash Anand , Hatch Spencer , Lu Yan , Cutter Gary R. , Zarjou Abolfazl
Published: October 2022

We conducted an anonymous survey in 9 of our university affiliated outpatient dialysis units to address the concern that many in-center hemodialysis patients may not feel comfortable sharing their experiences. Major goals of this study: Investigating level of patient satisfaction with their care; Evaluating the subjective perception of the level of understanding of patients regarding pertinent issues of their disease and its management; Identifying potential avenues for care improvement. Survey was conducted in English, paper-based, with answer choices to individual questions for patient satisfaction and education graded using a 5-point Likert scale. Regarding potential areas of improvement, patients were asked to choose as many areas as deemed appropriate. To ensure anonymity, the completed surveys were folded and dropped into a box. Overall, 253 out of 516 (49%) screened patients were eligible and completed the survey. Patients expressed favorable responses regarding satisfaction (mean rating > 4 in each of 14 questions) and education (mean rating > 4 in 8 questions, > 3.5 in 2 questions) regarding hemodialysis. About 62% of overall study participants identified at least one area where they felt additional information would result in improvement of care. Our results indicate that patients undergoing outpatient hemodialysis were overall satisfied and had a good perceptive understanding about their health. Based on the patients’ input, strategies focused on addressing pain and discomfort, privacy, providing information about palliative care/hospice, mental health resources, and the process of kidney transplantation may promote improvement in overall quality of care.
Potential pathogenic mechanism of type 1 X-linked lymphoproliferative syndrome caused by a mutation of SH2D1A gene in an infant: A case report
Authors: Wang Yanchun , Wang Yan , Lu Weimin , Tao Lvyan , Xiao Yang , Zhou Yuantao , He Xiaoli , Zhang Yu , Li Li
Published: October 2022

Background:

X-linked lymphoproliferative syndrome (XLP) is a rare X-linked recessive inborn errors of immunity. The pathogenesis of XLP might be related to phophatidylinositol-3-kinase (PI3K)-associated pathways but insight details remain unclear. This study was to study an infant XLP-1 case caused by a mutation in SH2D1A gene, investigate the structural and functional alteration of mutant SAP protein, and explore the potential role of PI3K-associated pathways in the progression of XLP-1.

Methods:

The proband’s condition was monitored by laboratory and imagological examinations. Whole exome sequencing and Sanger sequencing were performed to detect the genetic disorder. Bioinformatics tools including PolyPhen-2, SWISS-MODEL and SWISS-PDB Viewer were used to predict the pathogenicity and estimate structural change of mutant protein. Flow cytometry was used to investigate expression of SAP and PI3K-associated proteins.

Results:

The proband was diagnosed with XLP-1 caused by a hemizygous mutation c.96G > T in SH2D1A gene resulting in a missense substitution of Arginine to Serine at the site of amino acid 32 (p.R32S). The mutant protein contained a hydrogen bond turnover at the site of mutation and was predicted to be highly pathogenic. Expression of SH2D1A encoded protein SAP was downregulated in proband. The PI3K-AKT-mTOR signaling pathway was fully activated in XLP-1 patients, but it was inactive or only partially activated in healthy people or HLH patients.

Conclusions:

The mutation c.96G > T in SH2D1A gene caused structural and functional changes in the SAP protein, resulting in XLP-1. The PI3K-AKT-mTOR signaling pathway may play a role in XLP-1 pathogenesis.
Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture
Authors: Song Yuanzheng , Pang Xia , Zhu Fahao
Published: October 2022

Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression is still controversial. Computed tomography images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0 (ANSYS, Inc., Canonsburg, PA), and a 1 to 10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction. Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement was in the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement was in the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc. A reduction in the thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to normal height and kyphosis. The reduction in the posterior longitudinal ligament can push the bone block in the spinal canal into the reset space and achieve a good reset.