bluuebunny/crossref_metadata_2025 huggingface dataset:
Anemia ‐ an initial manifestation of Bing‐Neel syndrome: A case report
Authors: Yang Xiaoqian , Chong Zonglei , Ma Congcong , Wang Guifang , Yan Chunxia
Published: November 2022

Rationale:

It is very likely that we will miss Bing-Neel syndrome (BNS) when its initial sign is anemia.

Patient concerns: A 59-year-old woman presented with episodic loss of consciousness, anemia, and extremity muscle strength scores (5-) and extremity tendon reflexes (++).

Diagnoses:

Magnetic Resonance Imaging (MRI) showed abnormal signal in the left hippocampus, left insula, and right occipital lobe. Quantitative serum immunoglobulins showed elevated immunoglobulinm (IgM) (60.6g/L). Bone marrow biopsy showed lymphoplasmacytic lymphoma (LPL) and tested positive for the MYD88 L265P mutation suggesting Waldenström macroglobulinemia (WM).

Interventions:

The patient underwent 3 plasma exchange treatments in the department of hematology followed by chemotherapy (cyclophosphamide for injection, bortezomib for injection).

Outcomes:

The patient’s condition improved after treatment.

Lessons:

Clinicians must remain vigilant, as BNS may be the only sign of WM progression in a patient well-controlled on treatment.
Pain management in surgical intensive care patients: A retrospective observational research
Authors: Dinse Christoph Moritz , Bucher Michael , Burgdorff Anna-Maria , Christel Annett , Flöther Lilit
Published: November 2022

Sepsis and septic shock are the most common causes of death in non-cardiac surgical intensive care units (ICU). Adequate analgesia is essential to achieve positive outcomes. There were differences in pain management between patients with and without sepsis or septic shock. The release of inflammatory mediators, especially cytokines, in sepsis or septic shock decreases the pain threshold. Septic intensive care patients probably require higher doses of opioids than do non-septic patients. A retrospective observational study was carried out in an anesthesiologic intensive care unit from January 1, 2014 to June 30, 2016. Patients were divided into 4 groups according to the following criteria: sepsis (“yes/no” and communication ability “yes/no”). After adjusting for the number of cases using the pairing method, a total of 356 patients were recruited. The endpoint of our study was defined as the “total opioid dose”. Statistical evaluations were performed using t tests and 2-factor analysis of variance. There was a significant difference in opioid doses between communicative and non-communicative ICU patients F(1, 352) = 55.102, P < .001). This effect was observed in the ICU patients with and without sepsis. The mean sufentanil dose was significantly higher in non-communicative patients than in communicative patients group (E(1, 352) = 51.435, P < .001, partial ƞ
2 = 0.144). The effect of higher opioid- (F(1, 352) = 1.941, P = .161) and sufentanil (F(1, 352) = 1.798, P = .342) requirement was not statistically significant due to sepsis. The hypothesis that sepsis decreases the pain threshold could not be proven in this study. The effect of a higher opioid requirement is not directly caused by sepsis but by communication ability. Furthermore, we were able to show through our investigations and especially through the data of the pain recording instruments that the septic and non-septic intensive care patients receive sufficient pain therapy treatment in our ICU. Regular pain evaluations should be performed on patients in the ICUs who are able to communicate and those who are not.
Phenotypic and genotypic characterization of multi-drug resistance Pseudomonas aeruginosa isolated from urinary tract infections of non-catheterized and catheterized Chinese patients: A descriptive study over 3 years
Authors: He Yanhong , Wu Lamei , Liao Pingming , Shen Lili , Yang Huijian
Published: November 2022

Urinary tract infections (UTI) are commonest infections, especially in catheterized patients. It is responsible of mortality and morbidity among hospitalized patients. The objectives of the study were to demonstrate the virulence factors and their genes of multi-drug resistance Pseudomonas aeruginosa causing UTI. A total of 366 non-catheterized and 171 catheterized patients’ (in whom the catheter was in > 48 hours duration) urine samples (one sample/patient) from both sexes were collected and processed. >105 colony forming unit was considered as Pseudomonas aeruginosa culture-positive. Antimicrobial susceptibility testing was done by the Kirby Bauer disc diffusion method (The Clinical and laboratory standards institute guidelines 2019). The virulence factors were detected by in vitro assay method and polymerase chain reaction was done to detect the resistance genes present in Pseudomonas aeruginosa. Biofilm production was detected by the microtiter plate method. Out of 537 urine samples a total of 280 (52%) were females and 257 (48%) were male patients. Out of 366 non-catheterized urine samples 42 (23.6%) grew Pseudomonas aeruginosa and out of 171 catheterized urine 23 (25.84%) grew Pseudomonas aeruginosa. All were multi-drug resistance strains. A total of 10 (23.80%), 42 (100%), 8 (19.05%), 24 (57.14%), and 36 (85.71%) produced the Metallo-β-lactamases, AmpC-β-lactamase, carbapenemase, strong biofilm, and twitching motility positive, respectively in non-catheterized urine samples. A total of 11, 34, 9, 28, and 37 were oxacillinases-23, multidrug efflux protein resistance, New Delhi metallo-ß-lactamase-1, Verona Integron-encoded MBL, and Pseudomonas specific enzyme gene detected in non-catheterized urine samples. A total of 8 (34.8%), 6 (26.01%), 4 (17.39%), 15 (65.2%), and 18 (78.26%) were produced Metallo-β-lactamases, carbapenemase, AmpC-β-lactamase, strong biofilm, and twitching motility positive, respectively in catheterized urine samples. A total of 6, 18, 4, 16, and 15 were oxacillinases 23, multidrug efflux protein resistance, New Delhi metallo-ß-lactamase-1, Verona Integron-encoded MBL, and Pseudomonas specific enzyme, respectively genes detected in catheterized urine samples. Biofilm formation and twitching motility showed correlation among culture-positive Pseudomonas aeruginosa strains from catheterized patients (Correlation coefficients = 6.2, 95% confidence interval: 5.4–7.2). A better hospital infection control practice and detailed investigation of the microevolution of Pseudomonas aeruginosa in UTI are needed.
Constructing a Tregs-associated signature to predict the prognosis of colorectal cancer patients: A STROBE-compliant retrospective study
Authors: Ping Guoqiang , Tian Yichen , Zhou Ziqiang
Published: November 2022

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related mortality worldwide. Regulatory T cells (Tregs) are a key constituent of immune cells in the tumor microenvironment (TME) and are significantly associated with patient outcomes. Our study aimed to construct a Treg-associated signature to predict the prognosis of CRC patients. The genes’ expression values and patients’ clinicopathological features were downloaded from TCGA and gene expression omnibus (GEO) databases. The single-cell RNA (scRNA) sequencing data of CRC were analyzed through the Deeply Integrated human Single-Cell Omics database. WGCNA analysis was used to select Tregs-associated genes (TrAGs). The infiltrated levels of immune and stromal cells were accessed through the ESTIMATE algorithm. Cox regression analysis and the LASSO algorithm were implemented to construct prognostic models. Gene set enrichment analysis (GSEA) was performed to annotate enriched gene sets. Based on scRNA sequencing data, our study uncovered that more Tregs were significantly enriched in the TME of CRC. Then we identified 123 differentially expressed TrAGs which mainly participated in immune regulation. Given that CRC patients were reclassified into 2 subgroups with distinct overall survival based on 26 differentially expressed TrAGs with prognostic values, we subsequently constructed a signature for CRC. After training and validating in independent cohorts, we proved that this prognostic model can be well applied to predict the prognosis of CRC patients. Further analysis exhibited that more tumor-suppressing immune cells and higher immune checkpoint genes were enriched in CRC patients with high-risk scores. Moreover, immunohistochemistry analysis validated that the genes in the prognostic model were significantly elevated in CRC tissues. We were the first to construct a prognostic signature for CRC based on TrAGs and further revealed that the poor prognosis of patients was mainly attributed to the tumor-suppressing microenvironment and upregulated immune checkpoint genes in tumor tissues.
Obstetrician–gynecologists’ perspectives towards medication use during pregnancy: A cross-sectional study
Authors: Alshebly Mashael M. , Alghadeer Sultan , Alwhaibi Abdulrahman , Alturki Haya , Alghaith Jeelan , Mubarak Abdullah M. , Almadi Bana
Published: November 2022

A vast majority of studies evaluated pregnant women’s knowledge and attitudes towards using medications during their pregnancy, with few global and lack of regional studies conducted to spot obstetrician-gynecologists practices in this regard. This study aims to assess Obstetrician–gynecologists’ knowledge of medication teratogenicity potential, their frequently used resources, and their residency training contribution to medication use during pregnancy. This is a cross-sectional, survey-based study targeting licensed Obstetrician–gynecologists who are practicing in Saudi Arabia using a validated self-administered web-based questionnaire developed by the American College of Obstetricians and Gynecologists. A total of 60 obstetrician-gynecologists were included in the study. Most participants were female (72%) with median age and clinical experience of 42 and 13 years, respectively. The majority (87%) agreed that Isotretinoin is contraindicated, while around 60% of respondents were unsure about the safety of herbal remedies use. Online databases (e.g., Lexi-Comp and Micromedex) were chosen as the top utilized medication resources (45%). Around 48% strongly agreed that liability is a concern if there were adverse pregnancy outcomes following the use of medications. Regarding their training assessment, obstetrician-gynecologists who had been in practice for more than 15 years were significantly more likely to rate themselves as well qualified (P value < .05). The majority adequately and significantly rated their training on prescribed medications (58.3%), OTC medications (45%) and dietary supplements or herbal remedies (32%) (P value < .05). Obstetrician–gynecologists showed a different level of knowledge about the risks and safety of medications when used during pregnancy. More efforts are needed to optimize medication selection, herbal avoidance, and training performance.
Multisensory stimulation and rehabilitation for disability improvement: Lessons from a case report
Authors: Lo Buono Viviana , Torrisi Michele , Leonardi Simona , Pidalà Alessandra , Corallo Francesco
Published: November 2022

Rationale:

Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability. The treatment of patients diagnosed with spastic quadriplegia is complex and multidisciplinary. In this case report we described the positive effect of multisensory environment (MSEs) rehabilitation, and the strategies and technologies used to provide child who have to severe spastic quadriplegia and intellectual disability, palsy with playful and fun activities designed according to his abilities.

Patient concern:

A 7-years-old boy diagnosed with spastic quadriplegia and severe intellectual disability began rehabilitation by MSEs.

Diagnoses:

Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability.

Interventions:

Multisensory room is a large environment containing various elements where child can interact spontaneously and independently.

Outcomes:

The comparison scores between T0–T1 showed a reduction in self-harm and motor stereotypies (hand flapping). Sustained attention was improved and we observed a better therapeutic compliance by means of greater involvement in gaming activities.

Conclusion:

The stimuli within the MSEs provided the child opportunities to express himself with facilities more suited to his potential. Future research should project designed randomized controlled trials to examine the efficacy of multisensory on reduction disability.
Ewing sarcoma: what trends in recent works? A holistic analysis with global productivity: A cross-sectional study
Authors: Hassa Ercan , Aliç Taner
Published: November 2022

Advances in the biology of Ewing sarcoma, which continues to be an important cause of mortality, have caused an increase in information in the literature related to the underlying molecular base of the disease and discussions of new treatment approaches. In this study, we aimed to comprehensively analyze the published scientific articles on Ewing sarcoma. The Web of Science database was used to obtain and statistically analysis articles on Ewing sarcoma that were published between 1980 and 2021. Maps of network visualization were used to reveal trending topics, global collaborations, and the most effective studies. Correlation analysis was performed using Spearman’s correlation coefficient. A total of 3236 articles were analyzed. The first 3 countries that contributed the most to the literature and cooperated most intensively were USA (1194, 36.8%), Germany (293, 9%), Italy (254, 7.8%). Pediatric Blood & Cancer (n = 122), Cancer (87), Journal of Pediatric Hematology Oncology (71) were among the top 3 journals with the most articles. The most active author was Piero Picci (n = 94). High-income countries have a great effect on the literature on this subject. The most studied trend topics in recent years were pediatric oncology, EWS RNA Binding Protein 1 (EWSR1), EWSR1-FL1, epigenetics, bioinformatics, microRNA, gene expression, metastasis, migration, biomarker, immunotherapy, survival, outcomes, surveillance epidemiology and end results (SEER), nomogram, temozolomide, irinotecan, and drug resistance. Genetic studies, metastasis, immunotherapy, life analyses/nomogram based on new data obtained from SEER, and chemotherapy with irinotecan and temozolomide combination, were seen to be the topics researched in recent years.
Gastrointestinal, vaginal, nasopharyngeal, and breast milk microbiota profiles and breast milk metabolomic changes in Gambian infants over the first two months of lactation: A prospective cohort study
Authors: Karampatsas Konstantinos , Faal Amadou , Jaiteh Mustapha , Garcia-Perez Isabel , Aller Sean , Shaw Alexander G. , Kopytek Aleksandra , Witney Adam A. , Le Doare Kirsty
Published: November 2022

Microbiota composition in breast milk affects intestinal and respiratory microbiota colonization and the mucosal immune system’s development in infants. The metabolomic content of breast milk is thought to interact with the microbiota and may influence developing infant immunity. One hundred seven Gambian mothers and their healthy, vaginally delivered, exclusively breastfed infants were included in our study. We analyzed 32 breast milk samples, 51 maternal rectovaginal swabs and 30 infants’ rectal swabs at birth. We also analyzed 9 breast milk samples and 18 infants’ nasopharyngeal swabs 60 days post-delivery. We used 16S rRNA gene sequencing to determine the microbiota composition. Metabolomic profiling analysis was performed on colostrum and mature breast milk samples using a multiplatform approach combining 1-H Nuclear Magnetic Resonance Spectroscopy and Gas Chromatography-Mass Spectrometry. Bacterial communities were distinct in composition and diversity across different sample types. Breast milk composition changed over the first 60 days of lactation. α-1,4- and α-1,3-fucosylated human milk oligosaccharides, and other 33 key metabolites in breast milk (monosaccharides, sugar alcohols and fatty acids) increased between birth and day 60 of life. This study’s results indicate that infant gut and respiratory microbiota are unique bacterial communities, distinct from maternal gut and breast milk, respectively. Breast milk microbiota composition and metabolomic profile change throughout lactation. These changes may contribute to the infant’s immunological, metabolic, and neurological development and could consist the basis for future interventions to correct disrupted early life microbial colonization.
Effects and safety of Ophiocordyceps sinensis preparation in the adjuvant treatment for dialysis patients: A protocol for systematic review and meta-analysis
Authors: Liu Meixi , Chang Tianying , Zou Di , Cui ChengJi , Liu Chunyan , Zhang Shoulin , Liao Xing
Published: November 2022

Introduction:

Ophiocordyceps sinensis(O. sinensis), a genus of ascomycete fungi, has been intensively studied in various disease models, which is a rich source of various bioactive compounds and used in the treatment for end-stage renal disease patients. This systematic review highlights the therapeutic roles of O. sinensis as adjuvant treatment for dialysis patients with clinical evidence.

Methods and analysis:

The systematic review will be performed according to the Cochrane Handbook for Systematic Reviews of Interventions. The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Statement. An literature search strategy will be developed and adapted for 9 databases. Searches will be run from the database inception until the date of the search implementation and be updated before the review is completed. Randomized controlled trials that investigate the effects of O. sinensis for dialysis patients (peritoneal dialysis and hemodialysis) will be included. We will focus on outcomes recommended by the core outcome measures in effectiveness trials, including mortality, cardiovascular disease, infection, vascular access problems, dialysis adequacy, hyperkalaemia, life participation. Two researchers will independently screen the studies, extract data and evaluate study quality using the Risk of Bias 2 tool. Subgroup analysis will be performed according to peritoneal dialysis and hemodialysis. Sensitivity analyses will be conducted based on the Leave-1-Out Method. The Grading of Recommendations Assessment, Development, and Evaluation approach will be used to rate the quality of the evidence. Meta analysis will be performed using Review Manager 5.3 and R packages.

Objectives:

Studies have reported positive results of O. sinensis as adjuvant treatment for patients with dialysis. This review will synthesis current evidence on how O. sinensis can improve dialysis. Thus, it is expected that robust and conclusive evidence of the effects of O. sinensis during or after treatment can be obtained. These findings can inform future research and the selection of O. sinensis to promote quality of life for people with dialysis.
Efficacy of oral fecal microbiota transplantation in recurrent bowel disease: A protocol for systematic review and meta-analysis
Authors: Chen Qin , Zhang Zhiyun , Bei Shaosheng , Wang Xiaofeng , Zhu Yunying
Published: November 2022

Background:

Recurrent bowel disease (RBD) refers to the chronic, recurrent intestinal diseases, including recurrent Clostridium Difficile Infection (rCDI), inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), etc., these diseases have similar clinical characteristics, that is, abdominal pain, diarrhea, repeated attacks, prolonged recovery, etc. Clinically, there are relevant reports on the use of oral capsule fecal microbiota transplantation (oFMT) to treat RBD. However, both the advantages and disadvantages of clinical efficacy have been reported; there are some contradictions, the study sample size is too small, and the purpose of this systematic review was to evaluate the efficacy and safety of oral capsule fecal microbiota transplantation in the treatment of RBD.

Methods:

This systematic review will include articles identified through electronic searches of the PubMed, EMbase, and Cochrane Library. From inception to July 1, 2022. Two reviewers will independently search the database to conduct data extraction and assessment of study quality. Based on heterogeneity tests, data will be integrated using fixed or random effect models. RevMan V.5.4 will be used for data analysis. The results are expressed as the risk ratio of dichotomous data and the mean difference of continuous data.

Results:

We analyzed the clinical remission or cure rate, IBS-SSS, quality of life, anxiety, depression, total adverse effects, and total severe adverse effects (TSAE) in patients with RBD.

Conclusion:

This systematic review evaluated the efficacy and safety of oFMT in the treatment of RBD to provide more comprehensive evidence.
Pioglitazone on nonalcoholic steatohepatitis: A systematic review and meta-analysis of 15 RCTs
Authors: Zhao Yan , Zhao Wenli , Wang Hongwu , Zhao Ye , Bu Huaien , Takahashi Hirokazu
Published: November 2022

Background:

Nonalcoholic steatohepatitis is regarded as a risk factor of many liver diseases.

Methods:

Relevant studies were searched from The National Library of Medicine, Cochrane Library, Elsevier, China National Knowledge Infrastructure, Web of Science and WANFANG databases. A total of 15 eligible studies were analyzed in the Reviewer Manager 5.3 software, including 7 English articles and 8 Chinese articles.

Results:

Fifteen studies are selected for this meta-analysis, which includes totally 623 patients in the treatment group and 594 patients in the control group. As a result, 8 studies show that the total effective rate of the treatment group is higher than that of the control group [Z = 3.64, 95% confidence intervals (CI): 1.78 (1.31–2.43), P = .0003]; eleven studies show that fasting plasma glucose levels of the experimental group are lower than that of the control group [Z = 4.38, 95% CI: −0.95 (−1.38 to −0.53), P < .0001]; ten studies show that glutamic-pyruvic transaminase levels of the experimental group are lower than that of the control group [Z = 3.69, 95% CI: −11.76 (−18.01 to −5.51), P = .0002]; 6 studies show that glutamic oxalacetic transaminase levels of the experimental group are lower than that of the control group [Z = 7.40, 95% CI: −3.01 (−3.81 to −2.22), P < .00001]; 6 studies show that gamma-glutamyl transpeptidase levels of the experimental group are lower than that of the control group [Z = 2.43, 95% CI: −23.77 (−42.98 to −4.57), P = .02]; 9 studies show that triglyceride levels of the experimental group are lower than that of the control group [Z = 3.06, 95% CI: −0.62 (−1.01 to −0.22), P = .002]; 6 studies show that the homeostasis model assessment of insulin resistance of the experimental group is lower than that of the control group [Z = 3.22, 95% CI: −2.33 (−3.75 to −0.91), P = .001]; 6 studies show that the glycated hemoglobin A1c of the experimental group is lower than that of the control group [Z = 4.50, 95% CI: −1.90 (−2.72 to −1.07), P < .00001]; five studies show that the fasting insulin of the experimental group is lower than that of the control group [Z = 3.42, 95% CI: −2.25 (−3.53 to −0.96), P = .0006].

Conclusion:

Pioglitazone intake is effective in nonalcoholic steatohepatitis management.
Diagnostic performance and impact on patient management of [68Ga]Ga-DOTA-TOC PET/CT in colorectal neuroendocrine tumors derived from hindgut
Authors: Delabie Pierre , Baudin Éric , Hentic Olivia , Afchain Pauline , Rusu Timofei , Montravers Françoise
Published: November 2022

The main purpose of this retrospective study was to determine the diagnostic performance of [68Ga]Ga-DOTA-D-Phe1-Try3-octreotide(DOTA-TOC) positron emission tomography/computed tomography (PET/CT) in patients with well-differentiated colorectal Neuroendocrine Tumours (NETs) originating from the hindgut. The other aims were to assess the impact of the examination on patient management and to analyze the results of 2-[18F]FDG and/or 6-[18F]FDOPA PET/CT when they were performed. [68Ga]Ga-DOTA-TOC PET/CT and clinical data from 30 patients with biopsy-proven well-differentiated NETs originating from the hindgut were retrospectively reviewed and analyzed by comparing the [68Ga]Ga-DOTA-TOC PET/CT findings with pathological and/or follow-up data. We also compared the [68Ga]Ga-DOTA-TOC PET/CT results with 2-[18F]FDG and/or 6-[18F]FDOPA PET/CT results in 6 patients. The impact on management was determined in hindsight by comparing the patient management decided before and after the TEP examination based on data from multidisciplinary team meetings. On a patient basis, [68Ga]Ga-DOTA-TOC PET/CT was accurate in 30 of the 30 examinations. [68Ga]Ga-DOTA-TOC PET/CT correctly identified the primary tumor in all patients with primary tumors not resected before the examination and allowed the detection of unexpected distant metastases in 36% of the patients referred for initial staging. [68Ga]Ga-DOTA-TOC PET/CT findings affected patient management in 57% of cases with generally major intermodality changes. Intraindividual comparison of the results of the different PET radiopharmaceuticals showed a clear superiority of [68Ga]Ga-DOTA-TOC PET/CT considering both the number of lesions and the intensity of uptake. [68Ga]Ga-DOTA-TOC PET/CT is an accurate imaging modality for the assessment of well-differentiated colorectal NETs that highly impact patient management. Thus, we suggest that [68Ga]Ga-DOTA-TOC PET/CT be employed as a first choice for the assessment of these tumors in nuclear medicine.
High-viscosity versus low-viscosity cement for the treatment of vertebral compression fractures: A meta-analysis of randomized controlled trials
Authors: Li Yongbo , Tan Zhe , Cheng Yuanpei , Zhang Jixiang , Wu Han
Published: November 2022

Background:

High viscosity cement (HVC) and low viscosity cement (LVC) have been used to treat osteoporotic vertebral compression fractures (OVCFs). Our study was to assess the safety and efficacy of HVC and LVC in treating OVCFs.

Methods:

We searched the electronic database for randomized controlled trials of HVC and LVC to treat OVCFs. Random-effects model was performed to pool the outcomes about operation time, visual analogue scale (VAS), bone cement injection volume, oswestry disability index (ODI), bone cement leakage and adjacent vertebral fractures.

Results:

Twelve randomized trials were included in the meta-analysis. The 2 groups had similar changes in terms of bone cement injection volume, ODI and adjacent vertebral fractures. The HVC group showed shorter operation time and better VAS score improvement. The bone cement leakage rate of the HVC group was significantly better than LVC group (P < .00001).According to the location of bone cement leakage, in the leakages of the veins (P < .00001), the intervertebral disc (P < .00001), the paravertebral area (P = .003) and the intraspinal space (P = .03), the HVC group were significantly better than the LVC group.

Conclusions:

In terms of bone cement injection volume, ODI and adjacent vertebral fractures, the 2 group are equivalent. HVC had a shorter operation time, lower bone cement leakage rate and better VAS score improvement, compared with LVC.
Clinical efficacy and safety of sirolimus in childhood-onset systemic lupus erythematosus in real world
Authors: Zhang Lei , Cui Jie-Yuan , Zhang Lin
Published: November 2022

To investigate the effectiveness and safety of sirolimus in childhood-onset systemic lupus erythematosus in a real world. This is a retrospective real world clinical study. All childhood-onset systemic lupus erythematosus patients treated with sirolimus in Children’s Hospital of Hebei Province China were analyzed. They were treated with sirolimus and followed up regularly. The patients had systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, levels of antidouble-stranded DNA antibody, complement components C3 and C4, 24-hour proteinuria and corticosteroid reduction were recorded at baseline and at 6, 12, and 18 months. Adverse events were also collected. Thirty-two patients were enrolled in the study. SLEDAI-2K were improved on all time-points (P < .05). Complement levels increased and the levels of antidouble-stranded DNA antibody decreased during treatment. The mean dose of prednisone tapered and achieved significant reduction after 12 months therapy (15.4 ± 5.8 mg/d to 4.8 ± 2.1 mg/d; P < .05). Sirolimus was well tolerated and only 5 patients (15.6%) experienced adverse events, all of which were classified as infections (2 bacterial infection and 3 viral infections). No deaths, severe infusion reactions, or hypersensitivity reactions were found. Sirolimus use was associated with a decrease in disease activity and ability to tolerate tapering of oral glucocorticoid dose with a favorable risk–benefit profile.
Onset of spondyloarthritis in a patient treated with adalimumab for relapsing anterior uveitis – efficacy of secukinumab on the joint domain and on ocular inflammatory relapses: A case report
Authors: Raimondo Vincenzo
Published: November 2022

Rationale:

Adalimumab, an inhibitor of tumor necrosis factor-alpha, is a systemic non-corticosteroid agent approved for the treatment of noninfectious uveitis. Secukinumab, a human monoclonal antibody inhibiting interleukin 17A, is also being investigated as a potential treatment for noninfectious uveitis.

Patient concerns:

A 32-year-old Italian woman receiving adalimumab for relapsed anterior uveitis developed axial and peripheral clinical manifestations of spondyloarthritis during treatment.

Diagnosis:

Physical, laboratory and instrumental examination confirmed axial and peripheral spondyloarthritis associated with uveitis.

Intervention:

We decided to administer secukinumab 150 mg/month and interrupted the treatment with adalimumab 40 mg/2 weeks.

Outcomes:

The patient reported an evident remission of symptoms and improvement in clinical conditions.

Lessons:

Here we show the therapeutic efficacy of the switch from adalimumab to secukinumab, with remission of joint symptoms and reduction of inflammation indices, in the absence of new relapses of uveitis. This case suggests that secukinumab is primarily effective and safe on joints pain of an inflammatory nature in patients with anterior uveitis who develop spondyloarthritis as an extra-ocular symptom, while also seeming to be effective in preventing ocular symptoms recurrence.
The correlation of serum sirt6 with clinical outcome and prognosis in patients with gastric cancer
Authors: Li Danyang , Cao Cheng
Published: November 2022

Background:

We aimed to evaluate the correlation between serum sirtuin 6 (sirt6) level and clinicopathological characteristics and prognosis of gastric cancer (GC) patients.

Methods:

The serum sirt6 levels of subjects (135 cases of GC, 68 cases of atrophic gastritis, 60 cases of healthy controls) were analyzed by enzyme-linked immunosorbent assay. The predictive and prognostic values of sirt6 serum level for GC were determined by performing receiver operating characteristic curve (ROC), Kaplan–Meier analysis, as well as univariate and multivariate Cox regression, respectively.

Results:

GC patients showed lower sirt6 serum levels than that of atrophic gastritis patients and healthy control. Taking the healthy control as a reference, the area under the ROC curve (AUC) of sirt6 serum level for diagnosing GC was 0.955 with a sensitivity of 91.85% and a specificity of 90.0%. Based on ROC analysis using atrophic gastritis as the state variable, serum sirt6 had a high diagnostic efficiency for GC (AUC = 0.754). Serum sirt6 was related to the clinicopathological features (tumor size, Lauren’s classification, tumor node metastasis staging, lymph node metastasis) and overall survival (log-rank χ
2 = 12.22, P < .001). The AUC of serum sirt6 predicting death in GC patients was 0.731. At the optimal cutoff value (16.83 ng/mL), the sensitivity and specificity of sirt6 were 59.57% and 79.55%, respectively. Moreover, lower sirt6 level as independent risk factor was revealed to affect prognosis of GC patients (P = .018).

Conclusion:

Serum sirt6 level was positively associated with the tumor stage and metastasis conditions, which could be served as diagnostic and predictive biomarkers in GC.
Standing and supine positions are better than sitting in improving rightward deviation in right-hemispheric stroke patients with unilateral spatial neglect: A randomized trial
Authors: Onaka Hitoshi , Kouda Ken , Nishimura Yukihide , Tojo Hidenori , Umemoto Yasunori , Kubo Toshikazu , Tajima Fumihiro , Mikami Yukio
Published: November 2022

Trial design:

How body position affects unilateral spatial neglect (USN) is unclear. This cluster randomized trial aimed to examine the effects of different positions (supine, sitting, and standing) on USN in stroke patients.

Methods:

Twenty stroke patients (hemorrhage [n = 11], infarction [n = 9]) who were right-handed, had left hemiplegia due to right hemisphere damage that occurred within the last 2 years, and were in a state of arousal with a Glasgow Coma Scale score of 15 were included in the study. Table-top pen-and-pencil tests for USN (Bells Test, Line Bisection, Scene Copy, and Star Cancellation) were randomly conducted in the supine, sitting, and standing positions.

Results:

The mean values in each test were significantly smaller in the supine position than were those in the sitting position (P = .015, .047, .015, and <.001), and those in the standing position were significantly smaller than those in the sitting position (P = .007, <.001, =.006, and < .001). The results of the 4 tests in the standing position were similar to those in the supine position.

Conclusions:

Body position affects USN in stroke patients and that the standing and supine positions improve USN better than the sitting position. Some possible mechanisms are: muscle contractions in the lower limbs and the trunk could have affected results in the standing position, and reduction in gravitational stimulation in the supine position could have played a role.
Oxygen reserve index guided fraction of inspired oxygen titration to reduce hyperoxemia during laparoscopic gastrectomy: A randomized controlled trial
Authors: Ahn Jin Hee , Shim Jae-Geum , Park Jiyeon , Lee Sung Hyun , Ryu Kyoung-Ho , Cho Eun-Ah
Published: November 2022

Background:

The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO2) adjustment under a combination of ORi and peripheral oxygen saturation (SpO2) guidance can reduce intraoperative hyperoxemia compared to SpO2 alone.

Methods:

In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO2 group (FiO2 adjusted to target SpO2 ≥ 98%) or the ORi-SpO2 group (FiO2 adjusted to target 0 < 0 ORi < .3 and SpO2 ≥ 98%). The ORi, SpO2, FiO2, arterial partial pressure of oxygen (PaO2), and incidence of severe hyperoxemia (PaO2 ≥ 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO2 and ORi-SpO2 groups, respectively, were analyzed.

Results:

PaO2 was higher in the SpO2 group (250.31 ± 57.39 mm Hg) than in the ORi-SpO2 group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO2 was consistently higher in the SpO2 group than in the ORi-SpO2 group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO2 group (84.4%) than in the ORi-SpO2 group (16.7%, P < .001) 1 hour after incision. Higher FiO2 was administered to the SpO2 group [52.5 (50–60)] than the ORi-SpO2 group [40 (35–50), P < .001] 1 hour after incision. SpO2 was not different between the 2 groups.

Conclusion:

The combination of ORi and SpO2 guided FiO2 adjustment reduced hyperoxemia compared to SpO2 alone during laparoscopic gastrectomy.
Special presentation of bronchobiliary fistula after transcatheter arterial chemoembolization: A case report
Authors: Lo Yuan-Chun , Hsu Ping-Wen , Chew Fatt-Yang , Chen Hung-Yao
Published: November 2022

Rationale:

Transcatheter arterial chemoembolization (TACE) is a widely adopted treatment for advanced stage hepatocellular carcinoma (HCC). Nevertheless, several complications may occur, such as hepatic artery injury, nontarget embolization, pulmonary embolism, hepatic abscess, biloma, biliary strictures, and hepatic failure. However, bronchobiliary fistula is rarely mentioned before.

Patient concerns:

A 65-year-old man with HCC underwent the TACE procedure, and then he encountered fever, dyspnea, abdominal pain, and abundant yellowish purulent bronchorrhea.

Diagnosis:

Bronchobiliary fistula was diagnosed based on the computed tomography (CT) scan of his chest, which revealed the right lower lobe of his lung was connected to a hepatic cystic lesion.

Interventions:

Percutaneous transhepatic cystic drainage was performed, and we obtained yellowish bile, showing the same characteristics as the patient’s bronchorrhea.

Outcomes:

We kept drainage of his biloma and provided supportive care as the patient wished. Unfortunately, the patient passed away due to progressive right lower lobe pneumonia 2 weeks later.

Lessons:

This case exhibits a typical CT scan image that was helpful for the diagnosis of post-TACE bronchobiliary fistula. Post-TACE bronchobiliary fistula formation hypothesis includes biliary tree injuries with subsequent biloma formation and diaphragmatic injuries. Moreover, the treatment of bronchobiliary fistula should be prompt to cease pneumonia progression. Therefore, we introduce this rare complication of post-TACE bronchobiliary fistula in hopes that future clinicians will keep earlier intervention in mind.
A comprehensive review of the progress of cell migration inducing hyaluronidase 1
Authors: Miao Xiangguang , Wang Yukai , Miao Zhiguo , Pan Haili
Published: November 2022

The gene cell migration inducing hyaluronidase 1 (CEMIP) is on chromosome 15q25 and codes for a 150-kDa protein with an N-terminal secretion signal, a G8 domain, 2 GG domains, and several repeats. It was first described as a specific protein in the inner ear relating to nonsyndromic hearing loss. Recently, increasing research detected its association in various cancers, determining the progression, metastasis, and prognosis by influencing the proliferation and invasion of the cells. This relation is accomplished through various interacting pathways, such as the Wnt/β-catenin signaling pathway and the epidermal growth factor receptor signaling pathway. Thus, CEMIP could be a novel and potential focus for tumor diagnosis and treatment, but further studies on the regulatory role of CEMIP in vivo and in vitro are still needed. Herein, we summarize the process in recent studies of CEMIP, especially in cancer research.
Benefit and safety of antibiotics for Alzheimer’s disease: Protocol for a systematic review and meta-analysis
Authors: Gao Lin , Shuai Yinqi , Wen Lihong , Zhang Hong , Zhang Yi , Zhang Xiaoyun
Published: November 2022

Background:

Alzheimer's disease (AD) is an age-related degenerative change of the central nervous system, the cause of which remains unclear. Recent studies have found that brain inflammation caused by microbial infections may be one of the etiologies of AD, and antibiotics as novel treatments may be beneficial for delaying the development of AD. Several prospective studies have investigated the effects of different antibiotics on Alzheimer's disease. However, no systematic review or meta-analysis has evaluated the benefits and safety of antibiotics in AD patients.

Methods:

This study will analyze randomized controlled trials and observational studies published from database inception to December 31, 2022, and included direct or indirect evidence. Studies will be retrieved by searching PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Clinical Trials, CNKI, and Wan Fang databases. The outcomes of this study included the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog), Montreal Cognitive Assessment (MoCA), Standardized Mini-Mental State Examination (SMMSE), Clinical Dementia Rating (CDR), Frontal Functioning Scale (FAB), Dysfunctional Behavior Rating Instrument (DBRI), Activities of Daily Living (ADLs) Index, and Geriatric Depression Scale (GDS). The risk of bias will be assessed using the Cochrane risk-of-bias assessment instrument for randomized controlled trials. A random-effect/fixed-effects model will be used to summarize the estimates of the mean difference/risk ratio using a 95% confidence interval.

Results:

This study will analyze the benefits and safety of antibiotics in patients with AD.

Conclusion:

The results of this analysis will provide evidence to evaluate the benefits and safety of antibiotics in the treatment of AD.
A low-dose therapy of fibrinogen supplement during perioperative period of total knee arthroplasty in an asymptomatic man with congenital dysfibrinogenemia: A case report
Authors: Meng Decheng , Zhang Runzi , Ji Chenni , Gao Shijun , Wang Juan
Published: November 2022

Rationale:

Congenital dysfibrinogenemia (CD) is a rare coagulation system disease that is often treated without unified management. Individualized treatment thereof presents clinicians with great challenges.

Patient concerns:

A patient who was about to undergo total knee arthroplasty was found to have CD.

Diagnoses:

Coagulation screening revealed low fibrinogen, prolonged thrombin time, minor prolonged prothrombin time, and normal activated partial thromboplastin time were detected during admission, but no abnormal personal and family history findings were observed. Therefore, CD and hypofibrinogenemia were suspected. The gene sequencing confirmed the diagnosis of CD.

Interventions:

The patient received plenty and low level of fibrinogen concentrate during 2 perioperative periods, respectively.

Outcomes:

Successful clinical outcomes were obtained using different treatment strategies.

Lessons:

In contrast to prior case reports, this case illustrates the feasibility of low dosing of fibrinogen supplements within an asymptomatic patient in a selective operation. Changes in the level of fibrinogen and fibrin degradation product are of great importance for individualized treatment after supplementation.
Efficacy and safety of metronomic chemotherapy in maintenance therapy for metastatic colorectal cancer: A systematic review of randomized controlled trials
Authors: Chen Li , Cao Xin , Li Jing , Liu ChaoMin , Jiang Ting
Published: November 2022

Background:

The current studies on metronomic chemotherapy in mCRC are all aimed at patients after multi-line therapy failure, and only a few studies have focused on maintenance treatment after successful first-line therapy.

Methods:

The PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP were searched, and the relevant data was extracted, including media progression-free survival (mPFS), media overall survival (mOS), and grade 3/4 adverse events (AEs).

Results:

We included 4 randomized controlled trials (RCTs), 2 RCTs showed that metronomic maintenance chemotherapy could significantly improve mPFS compared to observation group; another RCT showed that metronomic maintenance chemotherapy group did not have low mPFS than the bevacizumab maintenance treatment (MT). The final RCT showed that dual-agent metronomic chemotherapy combined with bevacizumab MT did not improve mPFS compared with bevacizumab MT. The 3 RCTs showed that the metronomic maintenance therapy could not effectively improve mOS in mCRC compared to observation group or bevacizumab MT, while another RCT reported that the mOS in metronomic maintenance chemotherapy group was similar to bevacizumab MT. AEs was mostly mild and manageable. Grade ≥ 3 AEs are mostly nonhematological toxicity, and no deaths related to AEs were reported.

Conclusion:

This systematic review indicates that metronomic chemotherapy for mCRC MT can improve mPFS in some patients and is relatively safe. However, improvements in OS in most RCTs are arguable. Therefore, we need further studies to verify its long-term efficacy.
Therapeutic effectiveness and safety of sequential ICIs with radiotherapy for symptomatic brain and bone metastases in NSCLC patients
Authors: Tang Cuiping , Qin Si , Li Qian , Huang Yusheng
Published: November 2022

In advanced non-small cell lung cancer (NSCLC), the brain and bones are common metastatic sites, and the disease seriously affects the survival time and quality of life. For metastatic lesions with symptoms, local treatment often precedes systemic treatment. However, in clinical trials, patients with symptomatic brain or bone metastases are often excluded. Therefore, limited data are available on the efficacy of immune checkpoint inhibitors (ICIs) in those patients. We aimed to evaluate the effectiveness and safety of local radiotherapy followed by ICIs in driver gene-negative NSCLC patients with symptomatic local metastasis in the brain and bone. This is a 29-month 2 centered retrospective cohort study performed in China between March 2019 and August 2021. A total of 22 patients with advanced NSCLC were included. All patients received radiotherapy in the brain or bone before the administration of ICIs. For all patients, the overall response rate was 59.09%, the median progression-free survival (PFS) was 7.5 months, the PFS rate at 6 months was 72.73%, and the PFS rate at 1 year was 13.64%. Waterfall plots showed that tumor size was mostly reduced compared with baseline. The spider map showed that the tumor continued to shrink. In terms of symptom improvement, 100% pain control and 83.33% improvement were observed in epilepsy and neurological function. Sequential ICIs with local radiotherapy is effective for the treatment of patients with symptomatic brain and bone metastases of driver gene-negative NSCLC, which will benefit patients and improve their symptoms.