bluuebunny/crossref_metadata_2025 huggingface dataset:
Production of constitutive and induced secondary metabolites is coordinated with growth and storage in Norway spruce saplings
Authors: Huang Jianbei , Rücker Alexander , Schmidt Axel , Gleixner Gerd , Gershenzon Jonathan , Trumbore Susan , Hartmann Henrik
Published: March 2020

A mechanistic understanding of how trees balance the trade-offs between growth, storage and defense is limited but crucial for predicting tree responses to abiotic and biotic stresses. Here we investigated how trees allocate storage of non-structural carbohydrates (NSC) to growth and constitutive and induced secondary metabolites (SM). We exposed Norway spruce (Picea abies) saplings to 5 weeks of complete darkness to induce light and/or carbon limitation and then applied methyl jasmonate (MeJA) to simulate biotic attack. We measured changes in biomass, NSC (sum of soluble sugars and starches), and constitutive and induced SM (sum of phenolic compounds and terpenoids) in current-year developing and previous-year mature needles and branches, as well as volatiles emitted from the canopy. Under darkness, NSC storage was preferentially used for constitutive biosynthesis of monoterpenes rather than biosynthesis of stilbenes and growth of developing organs, while SM stored in mature organs cannot be remobilized and recycled. Furthermore, MeJA-induced production of SM was constrained by low NSC availability in developing organs but not in mature organs grown in the dark. Emissions of volatiles were suppressed in the dark but after 1 h of re-illumination, emissions of both constitutive and induced monoterpene hydrocarbons recovered rapidly, whereas emissions of linalool and sesquiterpene produced via de novo synthesis did not recover. Our results highlight that light and/or carbon limitation may constrain constitutive and JA-induced biosynthesis of SM in coordination with growth, NSC storage and mobilization.
“The COVID-19 Generation”: A Cautionary Note
Authors: Rudolph Cort W , Zacher Hannes
Published: March 2020

With COVID-19 presenting as a global pandemic, we have noticed an emerging rhetoric concerning “the COVID-19 Generation,” both anecdotally and across various media outlets. The narratives advanced to support such rhetoric have distinct implications for the study of work, aging, and retirement. In this commentary, we review this emerging issue and present evidence against attempts to define “the COVID-19 Generation” as a new construct along conceptual, methodological, as well as practical lines, with a specific focus on identifying real dangers associated with investigating and potentially managing a new generation associated with this pandemic. We strongly caution against the adoption of “the COVID-19 Generation” as a concept of study and instead offer several suggestions to researchers, organizations, and practitioners seeking answers to complicated questions about links between COVID-19 and various processes relevant to work, aging, and retirement during this time of uncertainty.
Comprehensive analysis of long non-coding RNA and mRNA expression profile in rectal cancer
Authors: Wang De-Zhong , Chen Guan-Yang , Li Yi-Feng , Zhang Neng-Wei
Published: March 2020

Background:

Rectal cancer (RC) is a malignant tumor that seriously threatens human health. Long non-coding RNAs (lncRNAs) play a vital role in tumor regulation. Nevertheless, their exact expression features and functions remain obscure, and therefore was the aim of the current study.

Methods:

We utilized the Affymetrix human GeneChip to screen differentially expressed profiles of lncRNAs and mRNAs from the cancer tissues and matched paracancer tissues of 6 RC patients. Gene Ontology (GO) and pathway enrichment analyses identified crucial functions and pathways of the aberrantly expressed mRNAs. We used quantitative real-time polymerase chain reaction to verify the significant expression differences of 11 candidate lncRNAs between the cancer and paracancer tissues. LncRNA-mRNA coexpression networks were built by calculating the Pearson correlation value to identify significant correlation pairs. Online bioinformatics tools GEPIA2, ONCOMINE, and PROGgeneV2 were used to mine the expression and prognosis of three crucial mRNAs and six verified lncRNAs. Competing endogenous RNA networks were constructed by predicting microRNA response elements and calculating free energy.

Results:

We found 1658 differentially expressed lncRNAs (778 up-regulated and 880 down-regulated) and 1783 aberrantly expressed mRNAs (909 up-regulated and 874 down-regulated). GO and pathway enrichment analyses revealed the vital functions of the differentially expressed mRNAs, including cell proliferation, cell migration, angiogenesis, and cellular response to zinc ion. The canonical signaling pathways mainly included the interleukin-17, cell cycle, Wnt, and mineral absorption signaling pathways. Six lncRNAs including AC017002.2 (P = 0.039), cancer susceptibility 19 (CASC19) (P = 0.021), LINC00152 (P = 0.013), NONHSAT058834 (P = 0.007), NONHSAT007692 (P = 0.045), and ENST00000415991.1 (P = 0.045) showed significant differences in expression levels between the cancer tissue and paracancer tissue groups. AC017002.2, NONHSAT058834, NONHSAT007692, and ENST00000415991.1 have not yet been reported in RC. The crucial mRNAs myelocytomatosis viral oncogene (MYC), transforming growth factor beta induced (TGFBI), and solute carrier family 7 member 5 (SLC7A5) were selected. AC017002.2 and LINC00152 were positively correlated with MYC, TGFBI, and cytochrome P450 family 2 sub-family B member 6 (All r > 0.900, P < 0.050). NONHSAT058834 was positively associated with MYC (r = 0.930, P < 0.001), and CASC19 was positively correlated with SLC7A5 (r = 0.922, P < 0.001).

Conclusion:

This study offers convincing evidence of differentially expressed lncRNAs and mRNAs as potential biomarkers in RC.
Rapid sequence induction
Authors: Klucka Jozef , Kosinova Martina , Zacharowski Kai , De Hert Stefan , Kratochvil Milan , Toukalkova Michaela , Stoudek Roman , Zelinkova Hana , Stourac Petr
Published: March 2020

BACKGROUND

Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction.

OBJECTIVE

The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations.

DESIGN

Online survey.

SETTINGS

A total of 56 countries.

PARTICIPANTS

Members of the European Society of Anaesthesiology.

MAIN OUTCOME MEASURES

The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia.

RESULTS

From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%,n=1081) of the respondents preoxygenated patients with 100% O2for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%,n=1571) and suxamethonium (56.0%,n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%,n=817) and opioids (54.9%,n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%,n=1153) and rocuronium (54.7%,n=741).

CONCLUSION

We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03694860
Epidemiology, Clinical and Microbiologic Profile and Risk Factors for Inpatient Mortality in Pediatric Severe Sepsis in the United States From 2003 to 2014: A Large Population Analysis
Authors: Thavamani Aravind , Umapathi Krishna Kishore , Dhanpalreddy Harshitha , Khatana Jasmine , Chotikanatis Kobkul , Allareddy Veerajalandhar , Roy Aparna
Published: March 2020

Objective:

To evaluate the national trends in pediatric severe sepsis in the United States from 2003 to 2014.

Study design:

For this study, we included nonoverlapping years of Kids Inpatient database and National Inpatient Sample database while including hospitalizations of children between 1 and 20 years of age from more than 4200 hospitals across the United States. We identified patient hospitalizations with severe sepsis using specific ICD codes and modified Angus Criteria. Trend analysis of various factors associated with severe sepsis was calculated using the Cochrane–Armitage test. Associated foci of infection and comorbid conditions were identified using specific ICD codes, and a multivariate regression analysis with death as outcome variable was done to evaluate for in hospital predictors of mortality.

Results:

Totally, 109,026 episodes of severe sepsis were identified during the study period between 2003 and 2014. Incidence of severe sepsis hospitalizations increased by 2.5 times (0.64–1.57 per 10,000 population) over the study period with notable concurrent significant decrease in mortality by more than 50%. Lower age, African American, Hispanic ethnicity, complex neurologic conditions, infective endocarditis, immunodeficient states including primary immunodeficiency disorder, HIV, burns, malignancy and transplant status are associated with mortality. There is a significant increase in use of healthcare resources (P < 0.001) with mean charges of 94,966$ despite a notable decrease in mean length of stay (22 vs. 16 days, P < 0.001) over the study period.

Conclusion:

Incidence of pediatric severe sepsis is high leading to a significant use of healthcare resources. This study provides a detailed analysis of associated inpatient factors and comorbidities associated with mortality.
Odontogenic Abscess With Orbital Extension Through the Inferior Orbital Fissure Treated With Bony Decompression
Authors: Rothschild Michael I. , Pinheiro-Neto Carlos D. , Rubinstein Tal J.
Published: March 2020

A 49-year-old otherwise healthy male presented with an odontogenic abscess and mild left facial swelling. CT imaging revealed gaseous hypodensities within the inferior orbital fissure and pterygopalatine fossa in addition to infection of the left masseter and temporalis muscle. Despite dental drainage, this rapidly progressed to orbital cellulitis with temporalis muscles abscess leading to compartment syndrome and globe tenting. He had an excellent outcome after canthotomy and cantholysis, urgent endoscopic and transconjunctival orbital decompression, temporalis muscle abscess drainage, and intravenous antibiotics. This case describes the use of bony orbital decompression for orbital compartment syndrome and globe tenting from odontogenic orbital cellulitis. In addition, this case radiographically demonstrates a transinferior orbital fissure passageway of an odontogenic abscess in the orbit.
Safety and efficacy data supporting U.S. FDA approval of intracameral phenylephrine and ketorolac 1.0%/0.3% for pediatric cataract surgery: clinical safety and pupil and pain management
Authors: Wilson M. Edward , Trivedi Rupal H. , Plager David A.
Published: March 2020

Purpose:

To assess the safety of phenylephrine and ketorolac (PE/K) 1.0%/0.3% compared with phenylephrine (PE) 1.0% in children aged 0 to 3 years undergoing cataract surgery. The effect of PE/K to PE on intraoperative pupil diameter and postoperative pain were also compared.

Setting:

Multicenter study in the United States.

Design:

Randomized double-masked phase 3 clinical trial.

Methods:

This study was powered to assess safety only. Depending on randomization, 4 mL of PE/K 1.0%/0.3% or PE 1.0% was injected into the surgical irrigation solution. Safety endpoints were assessed up to 90 days postoperatively. From surgical videos, a masked central reader measured the change in pupil diameter from immediately prior to incision to wound closure. Postoperative pain was measured using Alder Hey Triage Pain Score at 3 hours, 6 hours, 9 hours, and 24 hours following wound closure and recorded by parent/caregiver.

Results:

Seventy-two patients received masked intervention. There were no notable changes in vital signs or ophthalmological complications in either group. Mean change in pupil diameter was similar between PE/K 1.0%/0.3% and PE 1.0% (mean difference in area under the curve −0.071; P = .599). Postoperative ocular pain scores and overall mean scores were lower in PE/K group at all individual time points, and differences in overall mean scores were statistically significant at 6 and 24 hours (P = .029 and 0.021, respectively).

Conclusions:

PE/K 1.0%/0.3% was safe for use in children and maintained mydriasis during cataract surgery. Postoperative pain levels were lower in the PE/K 1.0%/0.3% group.
Energy Balance-Related Behaviors and Body Mass Index in Asian School-Aged Children With Congenital Heart Disease
Authors: Yang Fu-Ling , Gau Bih-Shya , Yang Hsiao-Ling , Lin Ming-Tai , Moons Philip
Published: March 2020

Background

Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health. Most studies on CCHD have taken place in Western societies, leaving Asian populations understudied, especially children.

Objective

We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD.

Methods

In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8% moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurements were taken in the hospital. Independent predictors of EBRBs and health conditions were calculated through logistic regression analysis.

Results

Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the New York Heart Association classification II to IV were associated with being overweight/obese.

Conclusions

Sedentary lifestyle is seemingly the only EBRB correlated with being overweight. Physical activity programs for children may help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries.
Reflections on Nursing Ingenuity During the COVID-19 Pandemic
Authors: Newby Jamison C. , Mabry Madison C. , Carlisle Byron A. , Olson DaiWai M. , Lane Blair E.
Published: March 2020

INTRODUCTION: This reflections article provides insight toward nursing innovations to reduce the overuse of personal protective equipment while maintaining a safe environment for staff taking care of COVID-19 patients. The secondary aim of this article to capitalize on recent advances in mass electronic communication through social media to encourage nurses across the globe to share their knowledge and expertise during this pandemic. INNOVATIONS: The many innovations that have been implemented fall into 3 categories of reducing unnecessary use of personal protective equipment, promoting staff safety and readiness, and reducing foot traffic. SUMMARY: These strategies are being shared to promote dissemination of innovative nursing interventions that will save lives during the COVID-19 pandemic.
Serum Metabolites in Hand-Arm Vibration Exposed Workers
Authors: Vihlborg Per , Graff Pål , Hagenbjörk Annika , Hadrévi Jenny , Bryngelsson Ing-Liss , Eriksson Kåre
Published: March 2020

Objective:

To investigate whether low molecular organic biomarkers could be identified in blood samples from vibration exposed workers using a metabolomics.

Methods:

The study population consisted of 38 metalworkers. All participants underwent a standardized medical examination. Blood samples were collected before and after work shift and analyzed with gas chromatography time-of-flight mass spectrometry. Multivariate modeling (orthogonal partial least-squares analysis with discriminant analysis [OPLS-DA]) were used to verify differences in metabolic profiles.

Results:

Twenty-two study participants reported vascular symptoms judged as vibration-related. The metabolic profile from participants with vibration-induced white fingers (VWF) was distinctly separated from participants without VWF, both before and after vibration exposure.

Conclusion:

Metabolites that differed between the groups were identified both before and after exposure. Some of these metabolites might be indicators of health effects from exposure to vibrations. This is the first time that a metabolomic approach has been used in workers exposed to vibrations.
Multicenter Study Investigating Foreign Language Acquisition at School in Children, Adolescents, and Young Adults With Uni- or Bilateral Cochlear Implants in the Swiss German Population
Authors: Beeres-Scheenstra Renske J. , Azar Alireza Rahimi , Heinzmann Sybille , Stieger Christof , Kompis Martin , Caversaccio Marco , Bodmer Daniel , Huber Alexander , Lehnick Dirk , Candreia Claudia , Linder Thomas E.
Published: March 2020

Objectives:

Evaluation of foreign language acquisition at school in cochlear implant patients.

Study Design:

Multicenter cohort study.

Setting:

CI centers.

Patients:

One hundred twenty-five CI users (10–18 yr) in the German-speaking part of Switzerland were enrolled. Demographic data were obtained by means of written questionnaires. German-speaking children with mainstream foreign language tuition (English and/or French) were enrolled for further testing. The control group of normal-hearing individuals was matched on age, class, and number of foreign language lessons attended.

Results:

Overall, 100 questionnaires were returned. The 12 CI users without foreign language learning attended special schools. CI users who attended foreign language classes had better German speech comprehension compared with those without foreign language tuition (89 versus 51%; p < 0.05). Thirty-one CI users of different grades were further tested. All (10/10) CI 6th graders attained the school objectives for both English reading and listening skills. French performance at 6th grade for reading was 3/7 and for listening only 1/7. There were 13 matched normal-hearing pairs for English and 10 for French. The total scores were on average 7% higher, with a statistical significance for English reading (p < 0.05).

Conclusions:

Almost 90% of CI children in Switzerland learn foreign language(s) at school. All the tested patients reached the current school objectives for English reading. The success rate for French was lower, especially regarding listening tasks. The 13 matched pairs with normal-hearing did not score substantially better.
Optimization of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing Using an Impulse Hammer in Adults, Adolescents, and Children
Authors: Rodriguez Amanda I. , Marler Elizabeth , Fitzpatrick Denis , Creutz Thomas , Cannon Shauntelle A. , Thomas Megan L. A. , Janky Kristen L.
Published: March 2020

Objective:

To characterize cervical and ocular vestibular evoked myogenic potential (c- and oVEMP) responses using an impulse hammer (IH) in adults and pediatrics at standardized force levels and evaluate: the relationship of force level on VEMP amplitude, sternocleidomastoid (SCM) contraction on cVEMP amplitude, required number of tap stimuli, and subject comfort. Using these data, optimal testing parameters were selected.

Study Design:

Prospective study.

Setting:

Tertiary referral center.

Patients:

Seventy-eight healthy adults, adolescents, and children with no hearing or vestibular deficits.

Interventions:

All subjects received c- and oVEMP testing using IH and 500 Hz tone burst air conduction stimuli. Adults received hard, medium, and soft force levels. Adolescents and children received medium and soft force levels. A comfort questionnaire was administered pre- and post-testing.

Main Outcome Measures:

IH VEMP response parameters (response rates, latency, cVEMP pre-stimulus SCM Electromyography [EMG], and peak-to-peak amplitude) were assessed per force level. Subjective reporting for patient comfort was also assessed.

Results:

VEMP response rates ranged from 92 to 100%. Force had a linear relationship with VEMP amplitude. SCM contraction had a linear relationship with raw cVEMP amplitude; however, dissipated with amplitude normalization. Force level did not impact the number of taps needed. A minimum peak force of 15 to 20 N, accounting for SCM contraction, and using a lower EMG monitoring limit for cVEMP is recommended to elicit reliable responses.

Conclusions:

Overall, IH VEMP is appropriate and comfortable to use in adults and pediatrics and can be useful when an air conduction stimulus is contraindicated or not preferred.
Allograft hemorrhage as a manifestation of carbapenem-resistant Klebsiella pneumonia infection in kidney transplant recipients
Authors: Wang Zhen , Qian Yeyong , Bai Hongwei , Yang Jintao , Li Xiang
Published: March 2020

Rationale:

Carbapenem-resistant Klebsiella pneumonia (CRKP) infections have been a concerning threat, especially in organ transplant patients with very high mortality. Allograft hemorrhage associated with CRKP infection has never been described.

Patient concerns:

A total of 6 recipients tested positive for CRKP were identified in 297 adult kidney transplant recipients who received kidney from donors according to Chinese type donation after cardiac death (DCD) at our center between January 2006 and December 2017.

Diagnoses:

CRKP identification was performed via Vitek 2 system, and the susceptibility was tested by broth microdilution and disk diffusion. Based on the signs of infection and the positive culture, the diagnosis of CRKP infection was established.

Interventions:

Therapy with antibiotic such as including ceftazidime-avibactam or tigecycline and surgical control of primary infection source including allograft nephrectomy and/or thorough debridement was administrated.

Outcomes:

The most striking aspect was that spontaneous recurrent hemorrhage occurred in all the 6 patients. The mortality of CRKP infection in our study was 50%.

Lessons:

CRKP infection possibly due to donor-to-recipient transmission in DCD kidney transplants was essentially a necrotic hemorrhagic inflammation and characterized by recurrent hemorrhage and high mortality. The pre-donation screening for CRKP colonization should be mandatory and, if positive, donation should be contraindicated. And, the effective infection source control such as allograft nephrectomy and/or thorough debridement was important to improve outcomes. Further investigation will be required to further characterize the clinical efficacy of new pharmacotherapeutic schemes including ceftazidime-avibactam.
Cardiac arrhythmia caused by a novel type of atrial conduction block
Authors: Cai Weixun , Xu Siyi , Li Xiaodong
Published: March 2020

Introduction:

We report an extremely rare case of atrial conduction block with unusual electrocardiogram (ECG) results, which has never been reported before. There are 2 types of atrial conduction block that result in atrial irregularities or complete atrial conduction block. The former is similar to other types of cardiac blocks such as sinus node to atrial block, atrial to ventricular block, or bundle branch blocks, which are characterized by 2 P waves at a specific frequency. This is due to the complete inner atrial block that results in the atrial muscle being divided into 2 parts without conduction between them so that each part has its rhythm generator. The objective of this report is to examine the cause of inner atrial conduction block and to promote awareness of this disorder.

Patient concerns:

An 81-year-old Chinese male patient was examined after complaining about chest discomfort, and it was found that he had atrial tachycardia; ECG results revealed a P wave loss at specific intervals (or P wave separation).

Diagnosis:

A diagnosis of P wave loss at specific intervals (or P wave separation) was made based on ECG results.

Interventions:

An ECG was performed on the patient

Outcomes:

It was unclear whether this patient has atrial separation or a new type of atrial conduction block, but our results revealed that this case presents a novel type of atrial conduction block, which we named ‘P wave block.’

Conclusion:

The type of EKG shown in this case has never been reported. This EKG shows a new type of conduction block in the atrium, temporarily named as a new type of P wave block.
Taohong Siwu decoction for femoral head necrosis
Authors: Chen Guoming , Xie Yaying , Liu Yunyun , Jin Shanmi , Chen Ziyin , Zhang Peng , Shi Peiyu , Zhu Junxia , Deng Jieyi , Liang Haorui , Zhou Chi
Published: March 2020

Backgrounds:

Femoral head necrosis is one of the most common orthopedic diseases which can be diagnosed in all ages with different reasons. Taohong Siwu decoction (TSD) has been widely used in the treatment of femoral head necrosis. However, as far as we know, there is still a lack of supporting evidence regarding the efficacy of TSD for femoral head necrosis. Therefore, this protocol aims to evaluate the effectiveness and safety of TSD for femoral head necrosis.

Methods:

Eight electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Technology Periodical database, (Chinese Scientific Journal Database) and Wanfang Database will be searched from the time when the respective databases were established to January 2020. Randomized controlled trials of TSD in the treatment of femoral head necrosis will be collected. After evaluating the quality of methodology and extracting valid data, the final meta-analysis will be carried out with software Revman 5.3.

Ethics and dissemination:

The results of this systematic review will offer implications of the use of TSD treatment for Femoral Head Necrosis. It uses aggregated published data instead of individual patient data and does not require an ethical board review and approval. The findings will be published in a peer-reviewed journal and disseminated in conference presentations.

Results:

The results of this study will offer implications of the use of TSD treatment for FHN with this meta-analysis.

Conclusion:

The conclusion of this study will provide recent evidence to assess whether TSD is effective and safe in the treatment of FHN.
Screening for mitochondrial 12S rRNA C1494T mutation in 655 patients with non-syndromic hearing loss
Authors: Gao Zhen , Yuan Ya-Sheng
Published: March 2020

Mutations in mitochondrial DNA, especially in 12S rRNA gene, are the most important causes for hearing loss. In particular, the A1555G and C1494T mutations have been found to be associated with both aminoglycoside-induced and non-syndromic hearing loss in many families worldwide. To determine the frequency of C1494T mutation in deaf patients, in the current study, we screened this mutation in 655 patients with non-syndromic hearing loss and 300 control subjects. After PCR amplification of mitochondrial 12S rRNA gene and direct sequence analysis, we found that there were 2 patients carrying the C1494T mutation; however, this mutation was not detected in 300 healthy subjects. Further genetic counseling suggested that only 1 patient had an obvious family history of hearing impairment. Clinical evaluation showed that 3 of 10 matrilineal relatives suffered from hearing loss, with different age at onset of hearing loss. Molecular analysis revealed the presence of homoplasmic 12S rRNA C1494T and ND5 T12338C mutations, together with a set of polymorphisms belonging to human mitochondrial haplogroup F2. Interestingly, T12338C mutation resulted in the replacement of the first amino acid, a translation-initiating methionine with a threonine, shortening 2 amino acids of ND5 polypeptide. Moreover, this mutation is located in 2 nucleotides adjacent to the 3’ end of the mt-tRNALeu(CUN) gene. Therefore, this mutation may alter ND5 mRNA metabolism and the processing of RNA precursors. Thus, the combination of T12338C and C1494T mutations may contribute to deafness expression in this family. Taken together, our data suggested that the C1494T mutation was the molecular basis for hearing loss, screening for the mitochondrial DNA pathogenic mutations was recommended for early detection, prevention, and diagnosis of mitochondrial deafness.
Elastic thread modified minimal access cranial suspension lift for lower and middle third facial rejuvenation
Authors: Yu Nanze , Yu Panxi , Liu Zhifei , Cho Jeongmok , Zhang Wenchao , Liu Yutong , Zhu Lin , Zeng Ang , Si Loubin , Long Fei , Xiao Yiding , Wang Xiaojun
Published: March 2020

Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.

Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.

All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.

The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.
Radiation exposure during endoscopic retrograde cholangiopancreatography according to clinical determinants
Authors: Oh Chi Hyuk , Dong Seok Ho , Kim Jung-Wook , Kim Gi-Ae , Lee Jae Min
Published: March 2020

This study aimed to analyze the dose of radiation to which the physician is exposed during endoscopic retrograde cholangiopancreatography (ERCP) and to identify predictive factors of radiation exposure during the procedure. Furthermore, we evaluated the patient characteristics and procedural factors associated with prolonged fluoroscopy time (FT).

A cross-sectional retrospective analysis of 780 ERCPs performed at a tertiary academic hospital over a 2-year period was conducted. The primary outcome was radiation exposure during ERCP as determined by FT; additionally, the association between variables and radiation exposure was determined. Moreover, we evaluated their correlations with age, sex, body mass index (BMI), diagnosis, duration of procedure, procedure name, and procedure complexity.

According to the analysis of the 780 ERCPs performed in 2 years, the mean FT was 5.07 minutes (95% confidence interval [CI], 4.87–5.26). The mean radiation durations were as follows: cholelithiasis, 5.76 minutes (95% CI, 4.75–6.80); malignant biliary obstruction, 6.13 minutes (95% CI, 5.91–6.35); pancreatic disease, 5.28 minutes (95% CI, 4.45–6.28); and benign biliary stricture, 5.32 minutes (95% CI, 5.02–5.94). Significant differences affecting fluoroscopy duration between the 2 endoscopists were not observed in the present study. Multivariate analysis revealed that prolonged fluoroscopy duration was related to specific characteristics, including higher BMI (BMI >27.5 kg/m2) (+4.1 minutes; 95% CI, 2.56–5.63), mechanical lithotripsy (+4.85 minutes; 95% CI, 0.45–9.25), needle-knife use (+4.5 minutes; 95% CI, 2.15–6.86), and malignant biliary obstruction (+2.34 minutes; 95% CI, 0.15–4.53).

ERCPs are associated with significantly higher radiation exposure of patients on the specific procedure. Endoscopists should be aware of the determining factors, including patients with obesity, who underwent mechanical lithotripsy, who had malignant biliary obstruction, and who underwent a procedure using a needle knife, that affect FT during ERCP.
Serum D-dimer as a potential new biomarker for prognosis in patients with thrombotic thrombocytopenic purpura
Authors: Wang Hai-Xu , Han Bing , Zhao Ying-Ying , Kou Lu , Guo Lu-Lu , Sun Tong-Wen , Song Lai-Jun
Published: March 2020

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease, and its mortality rate is 10% to 20%. However, there are currently only a few markers to predict the prognosis in patients with TTP. We aimed to identify several clinical indices and laboratory parameters for predicting the prognosis of TTP at admission.

A single-centre observational cohort study that included patients with TTP from the First Affiliated Hospital of Zhengzhou University in China was conducted from January 1, 2012 to November 30, 2018. The primary outcome was prognosis, including in-hospital mortality, major thromboembolic events, or failure to achieve remission at discharge. We used the random forest method to identify the best set of predictors.

Eighty-seven patients with TTP were identified, of whom 12 died during the treatment. The total number of patients within-hospital mortality, major thromboembolic events, and failure to achieve remission at discharge was 58. The machine learning method showed that the D-dimer level was the strongest predictor of the primary outcome. Receiver operating characteristic (ROC) analysis demonstrated that the sensitivity and specificity of the D-dimer level alone for identifying high-risk patients were 78% and 81%, respectively, with an optimum diagnostic cut-off value of 770 ng/mL. The area under the ROC curve (AUC) was 0.80, and the 95% confidence interval (CI) was 0.70 to 0.90.

This study found that the D-dimer level exhibited a good predictive ability for prognosis in patients with TTP. These findings may aid in the development of new and intensive treatment strategies to achieve remission among high-risk patients. However, external validation is necessary to confirm the generalizability of our approach across populations and treatment practices.
Comparative efficacy and safety of sunitinib vs sorafenib in renal cell carcinoma
Authors: Liu Xiu-Lan , Xue Hui-Ying , Chu Qian , Liu Jin-Yu , Li Juan
Published: March 2020

To evaluate the safety and efficiency of sunitinib and sorafenib in the treatment of renal cell carcinoma (RCC).

Databases were searched up till February 28, 2018. Two reviewers independently assessed trials for eligibility, quality, and extracted relevant data. Results are expressed as risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI). Six studies including 3112 patients were accessed. Sorafenib group exhibited higher median progression-free survival (mPFS) compared to sunitinib group (MD, −1.30; 95% CI, −2.56 to −0.03), especially in the first-line treatment (MD, −1.33; 95% CI, −2.61 to −0.04). However, sunitinib significantly reduced the risk of progression-free survival (PFS) compared to sorafenib (HR, 0.71; 95% CI, 0.6–0.82). Sunitinib also significantly reduced risk of overall survival (OS) compared to sorafenib (HR, 0.79; 95% CI, 0.65–0.92), while median OS was similar in both groups (MD, −0.48; 95% CI, −3.40–2.43). With regards to safety, the risk of rash (RR, 0.31, 95% CI, 0.12–0.79) was greater in sunitinib than sorafenib group, while the risk of decreased appetite (RR 2.10, 95% CI: 1.33–3.30) and dehydration (RR 2.73, 95% CI: 1.14–6.56) was smaller in contrast.

Based on risk of PFS and OS, sunitinib was a better treatment option for RCC treatment while patients faced with severe skin reaction. And for those Asian patients classified under MSKCC moderate risk, whether in first or second-line treatment, had difficulty in feeding, sorafenib is a better choice for prolong mPFS.
The efficacy and safety of acupuncture for Ramsay Hunt syndrome
Authors: Tan Ruijing , Yang Xingxin , Tang Xian , Ma Wenjie , He Lifen
Published: March 2020

Background:

Ramsay Hunt syndrome (RHS), also known as Hunt syndrome, is caused by varicella-zoster virus infection. The virus often invades the facial nerve geniculate ganglion to cause peripheral facial paralysis, accompanied by severe ear pain, auricular herpes zoster, tinnitus, deafness, vertigo, and other inner ear neurologic symptoms. The acupuncture has a long history as a traditional treatment of traditional Chinese medicine for the treatment of Hunt syndrome, with few adverse events and low cost. However, there are few evidences for the efficacy and safety of acupuncture for Hunt syndrome. Hence, we plan this systematic review and meta-analysis protocol to evaluate the efficacy and safety of acupuncture for Hunt syndrome.

Methods:

Four English databases will be searched from their inception to February 2019, including Cochrane Library, PubMed, Embase, OVID, and 4 Chinese databases, including Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], CQVIP, and Wanfang. No restriction was imposed for language or publication period. Randomized controlled clinical trials (RCTs) compared any form of acupuncture with/without additional treatment against sham or no treatment or same additional treatment. Data will be extracted and evaluated by 2 reviewers independently. RevMan 5.3 software will be used for data analysis when a meta-analysis is allowed.

Results:

This systematic review and meta-analysis will provide an evidence of acupuncture for RHS.

Conclusion:

This study will determine whether acupuncture is an effective and safe intervention for RHS. PROSPERO registration number: CRD 42019118283.
A case report of cryptococcal meningitis associated with ruxolitinib
Authors: Tsukui Daisuke , Fujita Hiroaki , Suzuki Keisuke , Hirata Koichi
Published: March 2020

We herein report a 76-year-old Japanese man with myelofibrosis who developed cryptococcal meningitis. After treatment for 5 months with ruxolitinib, the patient presented with fever and disturbance of consciousness. Marked nuchal stiffness was noted. The magnetic resonance imaging results of the brain were normal. Lumbar puncture showed an opening cerebrospinal fluid (CSF) pressure of 110 mm H2O, pleocytosis (85 mononuclear cells and 222 polymorphonuclear cells/μL), decreased CSF/serum glucose ratio (43%), and elevated protein (194 mg/dL). Blood and CSF cultures grew no bacteria or fungi. However, cryptococcal antigen was detected in the blood and CSF samples. We discontinued ruxolitinib and started administration of amphotericin B. His condition improved gradually 1 week after initiation of treatment. There have been only a few reports on cryptococcal meningitis associated with ruxolitinib. Physicians should consider the possibility of cryptococcal meningitis in patients receiving ruxolitinib.
Predisposing factors and prognosis of status epilepticus in patients with autoimmune encephalitis
Authors: Zhang Yu , Deng Chen , Zhu Lina , Ling Liu
Published: March 2020

The aim of this study was to study the predisposing factors and prognosis of status epilepticus (SE) in patients with autoimmune encephalitis (AE).

A total of 227 cases of AE were collected from the inpatient department of West China Hospital of Sichuan University from January 2010 to May 2018. All patients met the 2015 criteria for the diagnosis of AE. The binary logistic regression model was used to multivariate and retrospective chart analysis the predisposition factors for SE and its prognostic factors.

Of the 227 patients with AE, 50 (22.03%) had SE during hospitalization, and 19 patients with SE had a poor prognosis (modified Rankin score MRS = 3–6), and 7 patients with no SE had a poor prognosis. In the logistic regression model, electroencephalograms (EEGs) abnormalities (P = .000) and head magnetic resonance imaging (MRI) abnormalities (P = .003) were associated with a predisposition to SE, while Glasgow scores <8 (P = .027), abnormal EEG (P = .046), delayed immunotherapy (P = .012), and SE duration at admission lasting >30 minutes (P = .023) were risk factors for a poor prognosis of SE.

SE is a common complication in patients with AE. EEG and MRI abnormalities may be predisposing factors for SE. Glasgow scores <8 points, abnormal EEG, delayed immunotherapy, and SE duration lasting >30 minutes at admission are risk factors for a poor prognosis in patients with SE.
The role of SOX2 overexpression in prognosis of patients with solid tumors
Authors: Wang Shengjie , Liu Xinli , Chen Ying , Zhan Xiaozhen , Wu Tujin , Chen Bing , Sun Guangwen , Yan Songling , Xu Lin
Published: March 2020

Background:

Many studies have been done to reported the value of SRY-related HMG-box Gene 2 (SOX2) in prognosis of solid tumors. But results were not particularly consistent among these studies because of the limitations of the small sample data.

Methods:

We searched relevant studies published before November 2018 by PubMed, Web of Science and EMBASE. In this meta-analysis, hazard ratio (HR) values for overall survival (OS) were cumulatively pooled and quantitatively analyzed.

Results:

A meta-analysis based on 12 studies with 3318 patients was conducted to assess the potential correlation between SOX2 overexpression and OS in human solid tumors. A total of 12 studies (n = 3318) were assessed in the meta-analysis. It suggested that the high expression of SOX2 obviously indicates poor survival and prognosis in both univariate and multivariate analysis. In the univariate analysis, the combined HR for OS was 1.66 (95% confidence interval [CI]: 1.46–1.89, P < .001). The pooled HR of multivariate analysis for OS was 1.51 (95% confidence interval [CI]: 1.32–1.71, P < .001).

Conclusions:

This meta-analysis indicated that the high expression level of SOX2 is significantly associated with a decline in survival of human with solid tumors. On the basis of the expression level in solid tumors, SOX2 is expected to be a meaningful prognostic biomarker and effective therapeutic target.
Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery
Authors: Takenaka Shiho , Saeki Ayano , Sukenaga Norihiko , Ueki Ryusuke , Kariya Nobutaka , Tatara Tsuneo , Hirose Munetaka
Published: March 2020

Acute postsurgical pain, probably including acute neuropathic pain (ANeP), starts at the early postoperative period, and chronic postsurgical pain including chronic neuropathic pain (CNeP) persists at least 3 months after surgery. Although it must be important for prevention and treatment of acute and chronic postoperative pain to reveal the time course of postoperative neuropathic characteristics, a neuropathic pain profile after surgery has not been evaluated.

Pain status at the surgical site in adult patients who underwent video-assisted thoracic surgery (VATS) for lung cancer was prospectively assessed until 12 months after surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire until 6 days after surgery and the DN2 questionnaire throughout the study.

Twenty-seven patients were enrolled in this study. Pain intensity at surgical sites were significantly higher at 1 and 6 days after surgery during resting state, and were also significantly higher at 3, 6, and 12 months after surgery during movement than those before surgery. The incidence of ANeP was 33.3% at 1 day, and 18.5% at 6 days after surgery. The incidence of CNeP decreased to 12.5% at 3 months, 5.0% at 6 months, and 0.0% at 12 months after surgery. The number of neuropathic characteristics, assessed by DN2 scores, significantly increased at 1 and 6 days after surgery, compared to those before surgery. DN2 scores at 3, 6, and 12 months after surgery, however, showed no significant differences compared to those before surgery.

In patients with acute postsurgical pain, 20% to 30% of patients show ANeP characteristics, and the incidence of CNeP gradually decreases after VATS in patients with chronic postsurgical pain.
Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome
Authors: Zhang Ning , Yang Linqing , Wang Yunfei , Li Xiaoyu , Zhang Chao , Xu Jing
Published: March 2020

Rationale:

Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. This study aimed to report a case of primary hepatic pregnancy in a patient with polycystic syndrome.

Patient concerns:

A 30-year-old woman presented with vaginal bleeding after 63 days of amenorrhea.

Diagnosis:

The patient was initially diagnosed with liver ectopic pregnancy using abdominal ultrasound and abdominal computed tomography (CT).

Interventions:

The patient underwent laparoscopic exploration to reconfirm the gestational sac in the liver and abdominal surgery to remove liver gestation. The postoperative review of abdominal CT and the level of serum human chorionic gonadotropin (hCG) was performed.

Outcomes:

The postoperative pathological examination revealed a fluffy tissue in the liver tissue and a blood clot. The patient's vital signs were normal, and she was advised regular follow-up after discharge from the hospital. One month later, the serum hCG level reduced to 0.32 mIU/mL (reference range 0–5 mIU/mL).

Lessons:

If the level of beta-human chorionic gonadotropin (β-HCG) is higher than normal in women of childbearing age and no gestational sac is found in the uterine cavity, the location of pregnancy and gestational sac should be positively confirmed. Also, the possibility of ectopic pregnancy in the abdominal cavity should be considered, and the relevant imaging and biochemical examinations should be improved to avoid delay in diagnosis and treatment.
Both short and long sleep durations are associated with cognitive impairment among community-dwelling Chinese older adults
Authors: Ding Gongwu , Li Jinlei , Lian Zhiwei
Published: March 2020

This study aims to examine the association between sleep duration and cognitive impairment in community-dwelling Chinese older adults.

The associations between sleep duration and cognitive function have been widely studied across various age ranges but are of particular importance among older adults. However, there are inconsistent findings regarding the relationship between sleep duration and cognitive function in the literature.

This study is an observational cross-sectional study. We analyzed data from 1115 Chinese individuals aged 60 and older from 3 Chinese communities (Beijing, Hefei, and Lanzhou). Cognitive impairment was defined as a Mini-Mental State Examination total score less than 24 points. Odds ratios (ORs) of associations were calculated and adjusted for potential confounders in logistic regression models.

The prevalence of cognitive impairment was 25.7% (n = 287). Controlling for all demographic, lifestyle factors, and coexisting conditions, the adjusted OR for cognitive impairment was 2.54 (95% CI = 1.70–3.80) with <6 hours sleep and 2.39 (95% CI = 1.41–4.06) with >8 hours sleep.

Both short and long sleep durations were related to worse cognitive function among community-dwelling Chinese elderly adults.