bluuebunny/crossref_metadata_2025 huggingface dataset:
Choroidal vascularity index and thickness in sarcoidosis
Authors: Ugurlu Erhan , Pekel Gokhan , Akbulut Selen , Cetin Nazli , Durmus Sinan , Altinisik Goksel
Published: February 2022

Sarcoidosis is a multisystem granulomatous disease which is observed worldwide. Sarcoidosis is one of the common causes of ocular inflammation. The choroidal vascularity index, defined as the ratio of the luminal area to the total choroidal area, is used as one of the biomarkers for assessing the choroid vascular state. We aimed to compare choroidal vascularity index and thickness measurements between sarcoidosis patients and healthy controls.

Thirty-one patients with sarcoidosis and 31 age-gender matched healthy participants were recruited in this cross-sectional and comparative study. Choroidal vascularity index was defined as the ratio of luminal area to total choroidal area after binarization on optical coherence tomography images. Anterior segment examinations included central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, and iridocorneal angle. Spectral-domain optical coherence tomography was used to measure peripapillary retinal nerve fiber layer thickness, choroidal thickness, and retinal vessel caliber.

The mean choroidal vascularity index value was 61.6% in sarcoidosis patients and 62.4% in healthy controls (P = .69). The choroidal vascularity index and thickness were significantly correlated in both sarcoidosis (r = 0.41, P = .026) and control groups (r = 0.51, P = .006). Both the sarcoidosis and control groups had similar measured values for central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, and iridocorneal angle (P > .05). Mean retinal nerve fiber layer, retinal arteriole and venule caliber, and choroidal thickness measurements did not differ significantly between the groups (P > .05).

Sarcoidosis patients in quiescent period have similar choroidal vascularity index and thickness with healthy controls.
Benefits of physical exercise programs toward people with acquired brain injury
Authors: Pérez-Rodríguez Marta , Gutiérrez-Suárez Andrea , Barakat Ruben , Pérez-Tejero Javier
Published: February 2022

Background:

Exercise has proven to be a tool improving health related quality of life in people with acquired brain injury (ABI) as part of multidisciplinary team during the subacute and chronic phase. While intervention studies and revisions have been increased in recent years, there is no consensus about the type, frequency and variables of control in exercise interventions. Besides, this collective need programs that respond to different functional levels, given the heterogeneity of people with ABI, not only because of the etiology, but also because of the severity differences over their deficits. The aim of this systematic review and meta-analysis is to summarize the evidence regarding the relationship between exercise and health related quality of life in subacute and chronic phase.

Methods:

A protocol of systematic review and meta-analysis will examine the benefits of physical exercise (PE) toward people with ABI will be conducted. A comprehensive search will be conducted in the following electronic databases: MEDLINE, The Cochrane Library, CINAHL, SportDiscus, and Web of Science from inception to July 2020. Independent review authors will evaluate the title and abstract for each trial and disagreements will be solved by discussion with a third author if necessary. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the Stata software. The quality evaluation of this study will be completed using the Cochrane collaboration risk of bias tool and the risk of bias assessment will be conducted by the World Health Organization grading of recommendations, assessment, development, and evaluation. The review will be reported in accordance to the preferred reporting items for systematic reviews and meta-analyses statement.

Results and Conclussion:

This systematic review and meta-analysis protocol will provide an overview regarding the benefits of PE on functioning, social participation and quality of life toward people with ABI. The variability of outcomes across PE from the selected studies will provide important information for future trial designs. Results of the proposed review will inform practice and the design of future clinical trials. This study will summarize all the selected trials aimed at estimating the effectiveness of applying physical activity programs to ABI users.

Systematic review registration number: PROSPERO CRD42020191779.
Postoperative recurrence of gastric cancer depends on whether the chemotherapy cycle was more than 9 cycles
Authors: Li Yifan , Zhao Haoliang
Published: February 2022

We retrospectively reviewed the medical records of patients with pathologically confirmed gastric cancer/adenocarcinoma who underwent curative surgical resection follow-up within 3 years at Shanxi cancer hospital between 2002 and 2020. The clinicopathologic parameters explored included gender, age at surgery, vascular invasion, neural invasion, Tumor infiltration depth (T stage), N stage, TNM stage, chemotherapy, Lauren classification, maximum diameter of tumor, type of gastrectomy, tumor location and survival data.

With a median follow-up of 29 months (range 0–36 months), the ratio of patients with recurrence was 26.80% (n = 226) and the death rate of patients was 45.31% (n = 382) in this period. According to the results of univariate analysis, gender (P = .014), age at surgery (P = .010), vascular invasion (P = .000), neural invasion (P = .000), T stage (P = .000), N stage (P = .000), TNM stage (P = .000), chemotherapy cycle (P = .000), lauren classification (P = .000), maximum diameter of tumor (P = .000), type of gastrectomy (P = .000) were independent risk factors of recurrence of follow-up within 3 years. From the multivariate analysis by logistic regression showed that TNM Stage (P = .002), chemotherapy cycle (P = .000) were risk factors of recurrence of follow-up within 3 years. Univariate analysis of survival by Kaplan–Meier showed that gender (P = .038), vascular invasion (P = .000), neural invasion (P = .000), maximum diameter of tumor (P = .000), Lauren classification (P = .000), T stage (P = .000), N stage (P = .000), TNM Stage (P = .000) and type of gastrectomy (P = .000) were key factors linked to overall survival of follow-up within 3 years. The results of the multivariate analysis by Cox regression were clearly presented that T Stage (P = .000), TNM stage (P = .001), maximum diameter of tumor (P = .001) were key factors of overall survival of follow-up within 3 years.

TNM Stage, chemotherapy cycle were closely related to recurrence and of follow-up within 3 years. More than 9 cycles of chemotherapy was able to reduce the probability of recurrence. T Stage, TNM stage, maximum diameter of tumor were independent factors associated with overall survival of gastric cancer of follow-up within 3 years. For maximum diameter of tumor, the probability of death of more than 6 cm was 1.317 times less than 6 cm within 3 years of follow-up.
Clinical signs and symptoms associated with acute HIV infection from an intensely monitored cohort on 2 continents
Authors: Letizia Andrew G. , Eller Leigh Anne , Bryant Christopher , Dawson Peter , Nitayaphan Sorachai , Kosgei Josphat , Kibuuka Hannah , Maganga Lucas , Kroon Eugène , Sriplienchan Somchai , Michael Nelson L. , O’Connell Robert J. , Kim Jerome H. , Robb Merlin L.
Published: February 2022

Define the clinical presentation of acute human immunodeficiency virus infection (AHI) among men and women from 2 continents to create a clinical scoring algorithm.

Comparison of incident sign and symptom between those with and without AHI.

At-risk human immunodeficiency virus (HIV) negative men and women in Thailand, Kenya, Tanzania, and Uganda underwent twice-weekly testing for HIV. Newly diagnosed participants were evaluated twice weekly for 21 days after infection.

Of the 3345 participants enrolled, 56 African females and 36 biological males from Thailand were diagnosed with AHI. Four hundred fifty-two of their encounters were compared to 18,281 HIV negative encounters. Due to a high degree of heterogeneity among incident symptoms, 2 unique subgroups based upon geography and sex were created. Among Thai males, the signs and symptoms with the greatest odds ratio (OR) between AHI and uninfected participants were nausea (OR 16.0, 95% confidence interval [CI] 3.9–60.2, P < .001) and lymphatic abnormalities (OR 11.8, 95% CI 4.2–49.0, P < .001); and among African females were pain behind the eyes (OR 44.4, 95% CI 12.0–158.0, P < .0001) and fatigue (OR 22.7, 95% CI 11.3–44.3, P < .001). The Thai male scoring algorithm had a 66% sensitivity and 84% specificity while the African female algorithm had a sensitivity of 27% and specificity of 98%.

The different incident symptoms during AHI necessitated creating 2 different scoring algorithms that can guide diagnostic testing among a particular sex in the appropriate geographic setting. Further research on risk exposure, sex, and demographic specific models is warranted.
Prognostic value of targeted temperature management on outcomes of hanging-induced out-of-hospital cardiac arrest
Authors: Kim Jae Guk , Choi Hyun Young , Kang Gu Hyun , Jang Yong Soo , Kim Wonhee , Lee Yoonje
Published: February 2022

This study aimed to evaluate the prognostic significance of targeted temperature management (TTM) on hanging-induced out-of-hospital cardiac arrest (OHCA) patients using nationwide data of South Korea.

Adult hanging-induced OHCA patients from 2008 to 2018 were included in this nationwide observational study. Patients who assigned into 2 groups based on whether they did (TTM group) or did not (non-TTM group) receive TTM. Outcome measures included survival to hospital discharge and a good neurological outcome at hospital discharge.

Among the 293,852 OHCA patients, 3545 patients (non-TTM, n = 2762; TTM, n = 783) were investigated. After propensity score matching for all patients, 783 matched pairs were available for analysis. We observed no significant inter-group differences in the survival to hospital discharge (non-TTM, n = 27 [3.4%] vs TTM, n = 23 [2.9%], P = .666) or good neurological outcomes (non-TTM, n = 23 [2.9%] vs TTM, n = 14 [1.8%], P = .183). In the multivariate analysis, prehospital return of spontaneous circulation (odds ratio [OR], 22.849; 95% confidence interval [CI], 11.479–45.481, P < .001) was associated with an increase in survival to hospital discharge, and age (OR, 0.971; 95% CI, 0.944–0.998, P 
= .035), heart disease (OR, 16.875; 95% CI, 3.028–94.036, P 
= .001), and prehospital return of spontaneous circulation (OR, 133.251; 95% CI, 30.512–581.930, P < .001) were significant prognostic factors of good neurological outcome. However, TTM showed no significant association with either outcome.

There were no significant differences in the survival to hospital discharge and good neurological outcomes between non-TTM and TTM groups of hanging-induced OHCA patients.
The effectiveness of mindfulness-based stress reduction intervention on alleviating anxiety and depression in postoperative patients with cervical cancer
Authors: Yang Xiaoju , Huang Li , Li Chunlin , Ji Ning , Zhu Hongcheng
Published: February 2022

Background:

Surgical treatment for cervical cancer, as a stressor, largely leads to strong psychological reactions to stress like anxiety and depression. Whether mindfulness-based stress reduction (MBSR) can alleviate anxiety and depression in patients after cervical cancer surgery is controversial. Therefore, we aim to perform a meta-analysis involving randomized controlled trials analyzing the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery, thus providing evidence-based medical evidences for nonpharmacological interventions.

Methods:

Randomized controlled trials analyzing the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery will be searched in online databases, including Cochrane Central Register of Controlled Trials Repositories, PubMed, Embase, Web of Science, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan Fang Data. After screening eligible studies, we will perform a meta-analysis on the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery.

Results:

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

Conclusion:

This study will provide reliable evidence-based evidences for the effects of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery.

Ethics and dissemination:

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF Registration number:

DOI 10.17605/OSF.IO/EXUM3.
Lipoprotein glomerulopathy resulting from compound heterogeneous mutations of APOE gene
Authors: Li Yunsi , Chen Jin , Zou Yurong , Wang Wei , Li Guisen
Published: February 2022

Rationale:

Lipoprotein glomerulopathy (LPG) is a rare glomerular disease characterized by the deposition of lipoprotein thrombi in glomerular capillaries. The disease is characterized by proteinuria, progressive renal failure, and characteristic lipoprotein thrombosis in glomerular capillaries. Rare mutations in the apolipoprotein E (APOE) gene mainly contribute to disease pathogenesis.

Patient concerns:

A 28-year-old man presented with severe proteinuria and hyperlipidemia. The patient was treated with a full dose of prednisone for 2 months and then combined with leflunomide 20 mg daily for 20 days; however, his edema continued to worsen.

Diagnosis:

The patient was diagnosed LPG by laboratory examination and renal biopsy.

Interventions:

The patient was treated with atorvastatin (20 mg) combined with irbesartan (75 mg) once a day.

Outcomes:

The patient's lipidaemia and proteinuria were significantly reduced. Genetic testing showed that the patient carried compound heterozygous mutations in APOE. The APOE gene was inherited from her mother and father. Parents with a heterogeneous mutation had normal kidney function without proteinuria.

Lessons:

Usually, a single mutation in APOE can lead to the pathogenesis of LPG. This case shows that LPG could result from compound heterogeneous mutations of the APOE gene inherited from his mother and father. Intensive lipid-lowering combined with RASIs is effective in patients with LPG. Early renal biopsy and genetic mutation detection can avoid the unnecessary use of glucocorticoids and immunosuppressants.
Quantitative analysis of vascularity for thyroid nodules on ultrasound using superb microvascular imaging
Authors: Hong Min Ji , Ahn Hye Shin , Ha Su Min , Park Hyun Jeong , Oh Jiyun
Published: February 2022

This study aimed to investigate the utility of adding superb microvascular imaging (SMI) to B-mode ultrasound (US) for distinguishing between benign and malignant thyroid nodules and evaluate the usefulness of SMI quantification of nodular vascularity for diagnosing thyroid cancer.

The malignancy likelihood was scored for 3 datasets before versus after additional color Doppler imaging or SMI using 4-scale visual analysis (i.e., B-mode US alone, B-mode US + color Doppler image, and B-mode US + SMI). Further, the SMI pixel count was measured in the region of interest, including the whole nodule, on the longitudinal view. It was compared between benign and malignant nodules and analyzed according to the US patterns of thyroid nodules based on the Korean thyroid imaging reporting and data system. We calculated the area under the receiver operating characteristic curve values, sensitivities, and specificities.

There was no significant difference in the area under the receiver operating characteristic curve values among B-mode, B-mode + color Doppler, and B-mode + SMI. However, the SMI pixel count was significantly higher in malignant thyroid nodules than in benign ones. The optimal cut-off value for the SMI pixel count for predicting malignant thyroid nodules obtained using a receiver operating characteristic curve was 17 (40.54% in sensitivity, 91.3% in specificity). Analysis based on the US pattern of thyroid nodules revealed significant differences in the nodules with low-to-intermediate suspicious US features between malignant and benign nodules.

Quantification analysis of vascularity using SMI can differentiate malignant thyroid nodules from benign ones.
Acupuncture-related therapies for the poststroke cognitive impairment patients
Authors: Tian Jun , Hu Li-Bing , Wu Miao , Mo Wen-Li , Wu Peng , Pu Yao-Hui , Yang Han-Chao , Fan Yun
Published: February 2022

Background:

To compare and rank the clinical effects of different acupuncture and acupuncture-related therapies on patients with poststroke cognitive impairment.

Methods:

We evaluated the direct and indirect evidence from relevant studies using network meta-analysis. Eight databases were examined in order to find randomized controlled trials of acupuncture-related therapies for individuals with poststroke cognitive impairment. After 2 researchers independently scanned the literature, extracted the data, and assessed the risk of bias in the included studies, the data were analyzed using RevMan5.4, Stata15.0, and WinBUGS1.4.3 software.

Results:

We assess the benefits and drawbacks of various acupuncture-related therapies, rank the efficacy of various acupuncture-related therapies in the treatment of poststroke cognitive impairment, and describe the best acupuncture intervention approaches or combinations based on the available data.

Conclusion:

This study will contribute to the existence of data on the safety and efficacy of acupuncture-related therapies in the treatment of poststroke cognitive impairment, and it may aid clinical guideline makers in selecting the best acupuncture treatment for poststroke cognitive impairment.

Registration Number:

INPLASY2021120117.
A reliable nomogram model for predicting esophageal stricture after endoscopic submucosal dissection
Authors: Yang Guodong , Mu Zhao , Pu Ke , Chen Yulin , Zhang Luoyao , Zhou Haiyue , Luo Peng , Zhang Xiaoying
Published: February 2022

Currently, endoscopic submucosal dissection (ESD) has gradually become the diagnosis and treatment of choice for initial esophageal cancer. However, the formation of esophageal stricture after ESD is one of its important complications. In this paper, we intend to identify the risk factors of esophageal stricture to develop a nomogram model to predict the risk of esophageal stricture and validate this model.

A total, 159 patients were included in this study, including 21 patients with esophageal stenosis. Multivariate analysis showed that age greater than 60 years, high neutrophil-to-lymphocyte ratio, the extent of esophageal mucosal defect greater than 1/2, and postoperative pathological type of early esophageal squamous cell carcinoma were independent risk factors for predicting esophageal stricture. We constructed a nomogram model to predict esophageal stenosis by these 4 independent predictors.

The prediction performance of the model was verified by the area under the receiver operating characteristic curve, the area under the receiver operating characteristic curve of the model was 0.889, and the sensitivity and specificity were 80.00% and 91.28%, respectively, indicating that the prediction performance of the model was good; The calibration curve constructed by internal cross-validation suggested that the predicted results of the nomogram agreed well with the actual observed values.

The nomogram model has a high accuracy for predicting esophageal stricture after esophageal ESD and is extremely important to reduce or avoid the occurrence of esophageal stricture. But it needs more external and prospective validation.
The influence of carotid atherosclerosis on surgical outcomes of patients with cervical spondylotic myelopathy
Authors: Li Bohan , Liu Shuling , Wang Yongmei , Zhao Jie , Song Yang , Xu Wen , Zhang Cheng , Gao Chunzheng , Zhao Qian , Wu Dongjin
Published: February 2022

The appearance of atherosclerosis in the carotid artery may be suggest the possibility of atherosclerosis in the spinal cord artery, which can cause spinal cord ischemia and further lead to neural element damage.

According to the inclusion and exclude standard, there are 137 patients with cervical spondylotic myelopathy (CSM) incorporating retrospective analysis. These patients were consecutively admitted into The Second Hospital- Cheeloo College of Medicine-Shandong University from January 2016 to December 2018 and have accepted surgical treatment. All patients were examined by color Doppler ultrasound to detect carotid atherosclerosis before surgery. All patients were divided into 2 groups according to the presence or absence of carotid atherosclerosis: carotid atherosclerosis group (n = 88) and noncarotid atherosclerosis group (n = 49). All patients were followed up for at least 12 months after surgery. Demographic and surgery-related data were collected and analyzed to identify potential factors that affect the surgical outcomes in CSM.

The average age of carotid atherosclerosis group (51 males and 37 females), and noncarotid atherosclerosis group (24 males and 25 females) were 62.02 ± 10.34 years (range, 38–85 years) and 49.61 ± 10.28 years (range, 26–67 years), respectively.

In carotid atherosclerosis group: pre and postoperative modify Japanese Orthopedic Association Scores (mJOA score) were 11.58 ± 1.82 and 14.36 ± 1.64; the recovery rate of mJOA score was 45.57% ± 13.28%. In noncarotid atherosclerosis group: pre and postoperative mJOA score were 12.00 ± 2.11 and 15.04 ± 1.70; the recovery rate of mJOA score was 53.90% ± 13.22%. Univariate logistic regression analysis demonstrated that gender (P = .004), age ≥65 years (P = .001), duration of symptoms ≥12 months (P = .040), smoking history (P < .001), preoperative mJOA score ≤11 (P = .007) and carotid atherosclerosis (P = .004) were related to poor surgical outcomes. Multivariate logistic regression analysis showed significant correlations between poor surgical outcomes and age ≥65 years (P = .047), smoking history (P = .010), preoperative mJOA score ≤11 (P = .008) or carotid atherosclerosis (P = .047).

Carotid atherosclerosis may be a risk factor for poor surgical outcomes in CSM.
Nonalcoholic non-virus-related hepatocellular carcinoma arising from nonsteatotic liver
Authors: Shigematsu Yasuyuki , Kanda Hiroaki , Amori Gulanbar , Takahashi Yu , Takazawa Yutaka , Inamura Kentaro
Published: February 2022

Nonalcoholic non-virus-related hepatocellular carcinoma (NANV-HCC) is considered to occur in steatotic livers; however, emerging evidence indicates that a subset of NANV-HCC occurs in nonsteatotic livers. Currently, little information is available regarding this subset. This study sought to provide the clinical and pathological features of NANV-HCC in nonsteatotic livers.

We retrospectively investigated the clinicopathological features of 101 consecutive patients with NANV-HCC treated with a curative-intent hepatectomy. A background liver with <5% steatosis by area was regarded as a nonsteatotic liver. Survivals of patient subgroups were estimated using the Kaplan–Meier method, and log-rank tests were conducted to assess the survival difference. Multivariate analysis was performed with the Cox proportional hazards method.

Overall, 34 of 101 patients with NANV-HCC were found to have a nonsteatotic liver. Vascular invasion of the tumor was more frequently observed in patients with a nonsteatotic liver than in those with a steatotic liver (P = .03). The extent of lobular inflammation and fibrosis did not differ between patients with and without steatosis in the liver. NANV-HCC with a nonsteatotic liver was independently associated with a shorter disease-free survival (DFS) (hazard ratio [HR] 2.14; 95% confidence interval [CI] 1.21–3.80; P = .009) and a shorter overall survival (OS) (HR 2.79; 95% CI 1.27–6.16; P = .01) than NANV-HCC with a steatotic liver.

The absence of steatosis in the liver is independently associated with shorter DFS and OS in patients with NANV-HCC. Our findings indicate that nonsteatotic liver can be a surrogate phenotype of aggressive NANV-HCC.
Visualizing the features of inflection point shown on a temporal bar graph using the data of COVID-19 pandemic
Authors: Ho Sam Yu-Chieh , Chien Tsair-Wei , Shao Yang , Hsieh Ju-Hao
Published: February 2022

Background:

Exponential-like infection growth leading to peaks (denoted by inflection points [IP] or turning points) is usually the hallmark of infectious disease outbreaks, including coronaviruses. To determine the IPs of the novel coronavirus (COVID-19), we applied the item response theory model to detect phase transitions for each country/region and characterize the IP feature on the temporal bar graph (TBG).

Methods:

The IP (using the item difficulty parameter to locate) was verified by the differential equation in calculus and interpreted by the TBG with 2 virtual and real empirical data (i.e., from Collatz conjecture and COVID-19 pandemic in 2020). Comparisons of IPs, R
2, and burst strength [BS = ln(

) denoted by the infection number at IP(Nip) and the item slope parameter(a) in item response theory were made for countries/regions and continents on the choropleth map and the forest plot.

Results:

We found that the evolution of COVID-19 on the TBG makes the data clear and easy to understand, the shorter IP (=53.9) was in China and the longest (=247.3) was in Europe, and the highest R
2 (as the variance explained by the model) was in the US, with a mean R
2 of 0.98. We successfully estimated the IPs for countries/regions on COVID-19 in 2020 and presented them on the TBG.

Conclusion:

Temporal visualization is recommended for researchers in future relevant studies (e.g., the evolution of keywords in a specific discipline) and is not merely limited to the IP search in COVID-19 pandemics as we did in this study.
What makes acute cholecystitis recur after removing the percutaneous cholecystostomy tube?
Authors: Heo Jun , Jung Min Kyu , Cho Chang Min , Lee Sang Yub , Ryeom Hun Kyu , Chun Jae Min , Han Young Seok , Kwon Hyung Jun
Published: February 2022

Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter removal. This study aimed to evaluate the role of endoscopic sphincterotomy and other risk factors in reducing the recurrence of cholecystitis.

We retrospectively analyzed data from 1088 patients who underwent PTGBD for cholecystitis at Kyungpook National University Hospital, Republic of Korea, between January 2011 and April 2018.

A total of 115 patients were enrolled in the study. The recurrence rate of cholecystitis was 17.4% (n = 20) during a median follow-up period of 1159 (range, 369–2774) days. Endoscopic biliary sphincterotomy did not significantly affect the recurrence rate of cholecystitis (P = .561). In multivariable analysis, cystic duct stones (P = .013) and PTGBD catheter migration before the prescheduled removal time (P = .002) were identified as independent risk factors for cholecystitis recurrence after PTGBD.

To reduce post-PTGBD recurrence in cholecystitis, caution must be exercised to avoid inadvertent dislodging of the PTGBD catheter. In cases of cholecystitis with cystic duct stones, cholecystectomy should be considered only after careful assessment of postoperative risks. Instead, transluminal endoscopic gallbladder drainage could represent a promising option for the prevention of recurrent cholecystitis.
Angiogenin and MMP-2 as potential biomarkers in the differential diagnosis of gestational trophoblastic diseases
Authors: Weng Dan , Han Tao , Dong Jin , Zhang Ming , Mi Yang , He Yiping , Li Xiaojuan , Zhu Xiaoming
Published: February 2022

Background:

Gestational trophoblastic diseases (GTDs) are characterized by vascular abnormalities of the trophoblast, but their pathogenesis is unknown. Angiogenin (ANG) and matrix metalloproteinase (MMP)-2, which are molecules implicated in the angiogenic process, may play some role in this process.

Material and methods:

We determined ANG and MMP-2 in the placental tissues of 26 patients who had a benign mole (BM), 12 patients with gestational trophoblast neoplasia (GTN) (1 invasive hydatidiform mole, 10 choriocarcinomas, and 1 placental-site trophoblastic tumor), and 28 normal chorionic villi (NCV) subjects using immunohistochemistry staining. We obtained the serum samples from 20 patients with GTDs and 20 early pregnant women and evaluated them by the enzyme linked immunosorbent assay.

Results:

ANG expression in GTN (66.7%) and BM (100%) samples were both significantly higher (strong/intermediate staining) than in NCV (60.7%) samples (P < .001). Similarly, the immunoreactivities of MMP-2 in the GTN (66.7%) and BM (80.8%) samples were significantly elevated compared to that of the NCV (57.1%) samples (P < .001). The levels of ANG and MMP-2 in the maternal serum of the GTN group were both significantly higher than those of the control group (P < .001). ANG and MMP-2 expressions were associated with gestation age, clinical stage, and FIGO stage. A positive correlation between ANG and MMP-2 expression was observed (rs = 0.725; P < .01).

Conclusion:

ANG and MMP-2 levels were significantly elevated in the placental tissues and maternal serum from patients with GTDs. Further studies with more patients may clarify the vascular abnormalities in GTDs and determine potential biomarkers in the differential diagnosis of GTDs.
Network meta-analysis of heat-clearing and detoxifying oral liquid of Chinese medicines in treatment of children's hand-foot-mouth disease
Authors: Tang Jiqin , Zhang Gong , Xing Jinxiao , Yu Ying , Han Tao
Published: February 2022

Background:

Hand-foot-mouth is a viral infectious disease characterized by fever, hand foot rash and oral mucosal herpes caused by a variety of enteroviruses. It is often found in preschool children, and its immune system is not well developed, so it is very susceptible to infection by pathogens and epidemics, resulting in rapid progress of the disease. At present, the commonly used Chinese patent medicine oral liquid in our country has good clinical efficacy of antiviral, antibacterial, antiphlogistic and improving immunity, but there is no evidence to compare the clinical efficacy and safety of a variety of oral liquid of Chinese patent medicine. Therefore, this study is aim to use the network meta-analysis to integrate the clinical relevant evidence of direct and indirect comparative relationship, and to conduct quantitative comprehensive statistical analysis and sequencing after the aggregation of different Chinese patent medicine oral liquid with the same evidence body, and then the best clinical medication scheme is selected, which can provide reference value and evidence-based theoretical evidence for clinical optimization of drug selection.

Methods:

Comprehensive retrieval of CNKI, VIP, CBM, and WANFANG database and the Cochrane Library, PubMed, Web of Science and EMBASE database. Search and publish the clinical RCT of these 7 kinds of oral liquid of Chinese patent medicine compared with ribavirin or oral liquid of Chinese patent medicine. The retrieval time is from the establishment of the database to October 31st, 2021. The 2 first authors will screen the literatures that meets the inclusion criteria, extract the data independently according to the predesigned rules, and evaluate the literature quality and bias risk of the included research according to the Cochrane manual standard. Data merging and network meta-analysis were carried out with R programming software to evaluate the ranking probability of all interventions.

Results:

This network meta-analysis and probability ranking will identify the best Chinese patent medicine oral liquid treatment for Hand-foot-mouth.

Conclusion:

This study will provide systematic evidence-based medicine evidence for Chinese patent medicine oral liquid treatment for Hand-foot-mouth, and help clinicians, patients with poststroke depression and decision-makers to make more effective, safer and economic optimal treatment plan in the decision-making process.

Registration number:

INPLASY202210032. The protocol for this systematic review was registered on INPLASY and is available in full on the inplasy.com (https://inplasy.com/inplasy-2022–1-0032/).
Implementation of flipped classroom combined with case-based learning
Authors: Cai Li , Li Yan-li , Hu Xiang-yang , Li Rong
Published: February 2022

The popularity of flipped classroom (FC) is growing in medical education. However, the application of FC in pathology teaching has not been well explored. This study assessed the efficacy of FC combined with case-based learning (CBL) in undergraduate pathology education via comparison with a traditional lecture-based classroom (LBC).

A total of 117 third-year students were enrolled and assigned to the FC group (n = 59) or LBC group (n = 58) with demographic matches. Two sections in the pathology textbook (cardiovascular and respiratory system diseases) were chosen for the teaching content. Students in the FC group were required to study the preprovided course materials pre-class, followed by clinical case-based interactive group discussion in-class. Students in the LBC group were encouraged to preview and attended a didactic lecture in class. Post-class quizzes and Likert questionnaires were performed to investigate the efficacy and possible advantages of CBL-based FC over LBC.

The scores of the 2 groups in the mid-term examination of pathology before interventions were comparable. However, students in the FC group gained significantly higher scores in the post-quizzes than those in the LBC group, especially the scores regarding the questions of clinical case analysis. In the questionnaires, more students considered CBL-based FC to be beneficial to learning motivation, knowledge comprehension, critical thinking, patient management and teamwork than LBC. In addition, more students agreed that the FC model increased pre-class burden than LBC, rather than in-class pressure.

CBL-based FC modality has promising effects on undergraduate pathology education and may be a better choice than traditional LBC. Further optimizations are needed to implement this novel approach in pathology and other medicine curricula.
The radiographic assessments of spino-pelvic compensation using IoT-based real-time ischial pressure adjustment
Authors: Sohn Moon-Jun , Lee Haenghwa , Lee Byung-Jou , Koo Hae-Won , Kim Kwang Hyeon , Yoon Sang-Won
Published: February 2022

In malalignment syndrome, the spino-pelvic alignment correction with foot orthotics can be applied only to a standing position in the coronal plane. Considering the fact that the average time Koreans spend sitting in a chair is 7.5 hours per day, studies on spino-pelvic correction in sitting position is needed. The purpose of this study is to investigate the pressure changes and radiographic assessment of spino-pelvic alignment using a chair equipped with a height-adjustable seat-plate. This study was conducted on 30 participants with spinopelvic malalignment. All participants were subjected to measure buttocks interface pressure while seated using a smart chair in three consecutive steps:

Radiographically, the five spino-pelvic parameters such as shoulder height differences (SHD), iliac crest height differences (ICHD), leg length discrepancy (LLD), pelvic oblique angle (POA), and coronal imbalance were analyzed to investigate the effect of pelvic imbalance compensation on spino-pelvic alignment. Statistical analysis was performed using ANOVA and paired t test. The pressure discrepancy improvement between buttocks from 36.4 ± 32.3 mm on initial seated to 15.7 ± 20.3 mm on balancing, 12.7 ± 10.9 mm on 1hr balancing seated (Ω, P 
= 
.008). The radiographic results of pelvic imbalance compensation during seated show a statistical improvement of average SHD (from −0.9 to −0.8 mm, P = .005) and average ICHD (from 9.5 to 2.5 mm, P = .037). For a standing posture after use of smart chair, average SHD value (−3.0 to −1.0 mm, P = .005), ICHD (from 1.8 to 0.8 mm, P = .016), and average LLD value (0.8–0.1 mm, P = .033) were statistically significant improved.

Spine-pelvic malalignment can be improved by individually customized pelvic compensation using balanced seat plate height adjustments under the real-time pressure sensing and monitoring on the buttocks while seated.
Carpal tunnel syndrome and tenosynovitis in women with breast cancer associated with hormone therapy
Authors: Shin Dong Jae , Nam Kyung Eun , Song Dae Heon , Im Sun , Won Sun Jae , Kim Yeo Hyung , Lim Seong Hoon , Lee Jong In
Published: February 2022

The study aims to evaluate the characteristics, treatments, and incidence rates of carpal tunnel syndrome (CTS) and tenosynovitis in women with breast cancer, according to the hormone therapy used. We retrospectively reviewed women with breast cancer identified from the clinical data warehouse of the six hospitals in Korea, from January 2015 to August 2020. Among them, patients with CTS or tenosynovitis were reviewed in terms of disease status and treatments. A total of 101 patients among a population of 15,504 met the study inclusion criteria, so their clinical data were analyzed. Aromatase inhibitor (AI) users frequently needed oral medication for CTS, and developed severe CTS which frequently required surgery. AI users presented with a higher incidence of CTS (1.3%) than patients without hormone therapy (0.4%), and tenosynovitis occurred at a higher rate in AI users (2.3%) compared to the tamoxifen (1.1%) and no hormone groups (0.5%). More than half of the CTS and tenosynovitis occurred within 12 months after hormone commencement. The incidence and disease characteristics of CTS and tenosynovitis differed among the groups depending on the type of hormone therapy received. Our findings will help clinicians understand clinical courses and treatments for CTS and tenosynovitis in breast cancer patients.
Bioinformatics analysis of the clinical relevance of CDCA gene family in prostate cancer
Authors: Gu Peng , Yang Dongrong , Zhu Jin , Zhang Minhao , He Xiaoliang
Published: February 2022

Background:

Prostate cancer (PCa) is the second most frequent cancer in men worldwide, and its mortality rate is increasing every year. The cell division cycle-associated (CDCA) gene family plays vital roles in the cell cycle process, but an analysis of these proteins in PCa is still lacking.

Methods:

UALCAN and GEPIA were used to examine the transcriptional data and survival of the CDCA gene family in PCa patients. CDCA genetic alterations, prognostic value of genetic alterations, and correlations of CDCAs with each other in PCa were downloaded from cBioPortal. The functional enrichment data of CDCA-related genes were analyzed using DAVID.

Results:

Six CDCA genes were upregulated in PCa tissues relative to those in normal tissues (P < .001), including NUF2, CDCA2, CDCA3, CDCA5, CBX2, and CDCA8. The expression levels of the 6 CDCAs were related to the tumor Gleason score (P < .05). In addition, survival analysis using GEPIA suggested that PCa patients with increased NUF2, CBX2, and CDCA2/3/5/8 expression levels had poor relapse-free survival (P < .05). Distinct patterns of genetic alterations of the 6 CDCAs were observed in PCa, and pairwise comparison of the mRNA expression of the 6 CDCAs displayed a close relationship. The biological functions of CDCA-related genes are principally associated with the activation of the following pathways: cell cycle, Fanconi anemia pathway, microRNAs in cancer, oocyte meiosis, and homologous recombination.

Conclusions:

Upregulated CDCA (NUF2, CBX2, and CDCA2/3/5/8) expression in PCa tissues may play a crucial role in the occurrence of PCa. These CDCAs can predict relapse-free survival prognosis and the Gleason score of patients with PCa. Moreover, CDCAs probably exert their functions in tumorigenesis through the cell cycle and miRNAs in the cancer pathway.
Change in quality of life between primary laparoscopic cholecystectomy and laparoscopic cholecystectomy after percutaneous transhepatic gall bladder drainage
Authors: Park Jung Hyun , Jin Dal Rae , Kim Dong Jin
Published: February 2022

One of the most important reasons for avoiding percutaneous transhepatic gall bladder drainage (PTGBD) is the deterioration of quality of life (QOL). However, there is no study comparing the QOL between primary laparoscopic cholecystectomy (LC) and LC following PTGBD.

Among the LC patients, 69 non-PTGBD patients and 21 PTGBD patients were included after excluding the patients with malignant disease or who needed additional common bile duct procedures. Clinicopathologic characteristics and surgical outcomes were compared. QOL was evaluated with questionnaire EORCT-C30 before and after surgery.

The included patients comprised 69 non-PTGBD and 21 PTGBD patients. The PTGBD group include older and higher morbid patients. PTGBD group needed longer operation times than the non-PTGBD group (72.4±34.7 minute vs 52.8±22.0 minute, P = .022) Regarding the overall incidence of complication, the PTGBD group had a significantly higher complication rate than the non-PTGBD group (38.1% vs 10.1%, P = .003) However, there was no significant difference in severe complication). Regarding the QOL, both the functional and global health scales were improved following surgery compared to the preoperative evaluation. Comparative analysis of the 2 groups showed no significant difference in global heath scale either preoperative or postoperatively, while the functional scale and emotional scale were better in the PTGBD group compared to the non-PTGBD group. Regarding the symptom scale, postoperative dyspnea and perioperative diarrhea were better in the PTGBD group.

LC following an interval from earlier PTGBD that targets acute cholecystitis or complicated GB had little to no impact on QOL when compared to standard LC.
Differences in the Genomic Profiles of Immunoparalyzed and Nonimmunoparalyzed Children With Sepsis: A Pilot Study*
Authors: Farhat Mohamed Hani , Shadley Jeffery D. , Halligan Nadine L. N. , Hall Mark W. , Popova Antonia P. , Quasney Michael W. , Dahmer Mary K.
Published: February 2022

OBJECTIVES:

Sepsis-induced immunoparalysis represents a pathologic downregulation of leukocyte function shown to be associated with adverse outcomes, although its mechanisms remain poorly understood. Our goal was to compare genome-wide gene expression profiles of immunoparalyzed and nonimmunoparalyzed children with sepsis to identify genes and pathways associated with immunoparalysis.

DESIGN:

Prospective observational study.

PATIENTS:

Twenty-six children with lower respiratory tract infection meeting criteria for sepsis, severe sepsis, or septic shock admitted to the PICU.

SETTING:

Two tertiary care PICUs.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Innate immune function was assayed ex vivo by measuring release of tumor necrosis factor-α from whole blood after incubation with lipopolysaccharide for 4 hours. Immunoparalysis was defined as a tumor necrosis factor-α production capacity less than 200 pg/mL. Ten of the 26 children were immunoparalyzed. There were 17 significant differentially expressed genes when comparing genome-wide gene expression profiles of immunoparalyzed and nonimmunoparalyzed children (false discovery rate < 0.05). Nine genes showed increased expression in immunoparalyzed children (+1.5- to +8.8-fold change). Several of these dampen the immune system. Eight showed decreased expression in immunoparalyzed children (–1.7- to –3.9-fold change), several of which are involved in early regulation and activation of immune function. Functional annotation clustering using differentially expressed genes with p value of less than 0.05 showed three clusters related to immunity with significant enrichment scores (2.2–4.5); the most significant gene ontology terms in these clusters were antigen processing and presentation and negative regulation of interleukin-6 production. Network analysis identified potential protein interactions that may be involved in the development of immunoparalysis in children.

CONCLUSIONS:

In this exploratory analysis, immunoparalyzed children with sepsis showed increased expression of genes that dampen the immune system and decreased expression of genes involved in regulation and activation of the immune system. Analysis also implicated other proteins as potentially having as yet unidentified roles in the development of immunoparalysis.
Amyloid Arthropathy and Pseudomyopathy Associated With Multiple Myeloma Detected by 18F-Florapronol Amyloid PET/CT
Authors: Seo Minjung , Lee Yoo Jin , Kim Misung , Kang Byeong Seong , Park Seol Hoon
Published: February 2022

We report a case of amyloid arthropathy and pseudomyopathy with multiple myeloma, detected by amyloid PET/CT using 18F-florapronol. Bone scintigraphy and 18F-FDG PET/CT in a multiple myeloma patient revealed uneven soft tissue uptakes, especially at periarticular areas. The joint capsule and intermuscular fascia showed enhancement on CT, whereas muscle enzymes were normal. These suggested amyloid arthropathy with pseudomyopathy. 18F-Florapronol amyloid PET/CT showed extensive soft tissue uptakes. Amyloid arthropathy and pseudomyopathy were confirmed after biopsy. This is the first report of amyloid PET/CT aiding in the diagnosis of unusual presentation of systemic amyloidosis.
Endoscopic Management of Maxillary Sinus Schwannoma
Authors: Celik Turgut , Koca Cigdem Firat , Aydin Sukru
Published: February 2022

Schwannomas are benign tumors originate from nerve sheath. In this article, the authors aimed to share our experience and review the literature on endonasal endoscopic intervention for a maxillary sinus schwannoma. A 30-year-old Caucasian female patient applying to ophthalmology clinic due to exophthalmos and proptosis in her left eye for the last 6 months. A well-defined mass was detected in left maxillary sinus that was filling and expanding the sinus. Endoscopic biopsy from the patient was reported as ancient schwannoma. The encapsulated mass was completely removed by performing a combined endoscopic medial maxillectomy and Caldwell-Luc procedure under general anesthesia. The authors have been following the patient for 2 years and there was no evidence of recurrence, however, a decrease in the volume of the maxillary sinus occurred, suggesting chronic maxillary atelectasis. In conclusion, schwannoma should be considered in the differential diagnosis of sinonasal masses.