bluuebunny/crossref_metadata_2025 huggingface dataset:
630. Clinical and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in Qatar: A Retrospective and Prospective Observational Study
Authors: Ben Abid Fatma , Doi Yohei , Omrani Ali S , Deshmukh Anand , McElheny Christi L , Bachman William C , Erin Louise Fowler , Ming Tsui Kin , Almaslamani Muna , Al Khal Abdullatif , A Al Bishawi Ahmad A , Mushtaq Kamran , Mahmoud Mohamed Hamed Manal , Butt Adeel A
Published: July 2020

Background

There are limited data describing carbapenem-resistant Enterobacteriaceae (CRE) from the Arabian Gulf region. Our aims were to describe the clinical, microbiological and molecular characteristics of CRE infections and to characterize the gene displaying resistance to carbapenem.

Methods

Retrospective and prospective review of clinical, microbiological and molecular characteristics of CRE isolated between April 2015 and November 2017 at 7 tertiary hospitals in Qatar. Susceptibility testing was performed and interpreted according to Clinical Laboratory Standards Institute methodology and breakpoints. Carbapenemase genes were identified using PCR. Whole-genome sequencing followed by bioinformatics analysis was performed on a subset of samples for accurate detection of resistant genes. SPSS V.21.0 was used for all statistical analyses.

Results

A total of 144 nonrepeating CRE strains were recovered from 137 individuals over the study period, of which 35 (24.3%) represented colonization. Klebsiella spp. (98, 68.1%) and E. coli (38, 26.4%) were the most predominant. The most prevalent carbapenemases were NDM (69, 47.9%), OXA-48 (36, 25.0%), and KPC (15, 10.4%). Sixteen (11.1%) strains possessed multiple carbapenemase genes but none were detected in 37 (25.7%) strains. Genomic analysis also detected the presence of NDM-7, NDM-5, NDM1, VIM4, and OXA48-like carbapenemase genes among 34 clinical samples. The majority of the strains were susceptible to tigecycline (124, 86.1%), fosfomycin (122, 84.7%) and amikacin (102, 70.8%). There were 109 CRE infections involving the urinary tract (40, 36.7%), bloodstream (31, 28.4%), and respiratory tract (17, 15.6%). Fifty-seven (52.3%) were males and the median age was 57 years (range 3–97). Baseline comorbidities included diabetes (57, 52.3%), chronic kidney disease (27, 24.8%), and cancer (27, 24.8%) (Table 1). Within the 30 days preceding CRE infection, 38 (34.9%) had received carbapenem therapy, 65 (59.6%) had undergone invasive procedures and 33 (30.3%) had had surgery. All-cause 30-day mortality was 29.4%. The only variable independently associated with mortality was baseline SAPS Score (Table 2).

Conclusion

NDM and OXA-48 are the predominant carbapenemases in Qatar. CRE infections are associated with high overall mortality.

Disclosures

All authors: No reported disclosures.
719. Cefiderocol Retains Anti-Biofilm Activity in MDR Gram-Negative Pathogens
Authors: Pybus Christine A , Greenberg David E
Published: July 2020

Background

Cefiderocol is a siderophore cephalosporin with potent antibacterial activity against a broad range of Gram-negative pathogens. Microorganisms forming biofilm, e.g., cUTI, utilize bacterial siderophores to access free iron. A siderophore antibiotic may have unique antimicrobial properties in the setting of biofilm. In this study, we compared antimicrobial activity of cefiderocol to comparator antibiotics in well-characterized multi-drug-resistant pathogens. We determined the activity of cefiderocol and comparator antibiotics in the biofilm setting.

Methods

Minimum inhibitory concentrations (MICs) in Mueller–Hinton II broth (MHII) and iron-depleted cation-adjusted MHII (ID-CAMHB) were determined for cefiderocol and seven comparator antibiotics in multidrug-resistant isolates of P. aeruginosa, Burkholderia cepacia complex (Bcc), Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. MBEC (minimum biofilm eradication concentration) assays were used to test cefiderocol’s activity in biofilms formed on pegs. Total biofilm biomass and viable cell number were measured.

Results

The MIC90 of cefiderocol ranged from 0.125 μg/mL (Bcc) to 1 μg/mL (P. aeruginosa) in ID-CAMHB. MIC90 values were consistently lower for cefiderocol in all strains tested compared with other agents (ceftolozane-tazobactam, ceftazidime–avibactam, ceftazidime, pipercallin-tazobactam, imipenem, tobramycin, clarithromycin). Twenty-four hour P. aeruginosa biofilms (strains ATCC 9027, MB640, MB771, MB580A, MB730) were treated every 12 hours with 4 μg/mL of cefiderocol or comparator antibiotics. Cefiderocol treatment displayed a superior reduction in biofilm based on colony counts ( >90%; P < 0.0001 vs. untreated control) compared with comparator drugs (50 to 80% reduction). Crystal violet staining revealed a dose-dependent response of cefiderocol in the reduction of biofilm. Reduction of biofilm was not significantly altered by the growth media that was used; however, P. aeruginosa strains form more biofilm in MHII.

Conclusion

Cefiderocol effectively reduces biofilm in multidrug-resistant strains of P. aeruginosa and is a potent inhibitor of planktonic growth across a range of Gram-negative medically important pathogens.

Disclosures

All authors: No reported disclosures.
773. First National Survey of Antibiotic Use Prescribed by All Dentists in Japan from 2015 to 2017 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)
Authors: Ishikane Masahiro , Tanaka Chika , Ono Sachiko , Kusama Yoshiki , Tsuzuki Shinya , Muraki Yuichi , Yamasaki Daisuke , Tanabe Masaki , Ohmagari Norio
Published: July 2020

Background

The surveillance of antimicrobial use (AMU) among medical doctors and dentists is a key component of the Japanese national plan on antimicrobial resistance (AMR). However, there are no epidemiological studies of AMU among dentists in Japan. We aimed to evaluate the epidemiology of AMU among dentists in Japan and investigate the factors affecting inappropriate prescribing.

Methods

Total AMU among dentists in Japan between 2015 and 2017 was analyzed by using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), from the Ministry of Health, Labor and Welfare of Japan, which accounted for 98% of total claim data in Japan. Antimicrobials were classified by the World Health Organization (WHO) Anatomical Therapeutic Chemical Classification. The WHO measures antimicrobial usage by using the Defined Daily Dose per 1,000 inhabitant-days (DID) parameter. The patterns of oral AMU in 2017 in outpatient settings were compared between in-house and outside prescriptions.

Results

DID values of total AMU in 2015, 2016, and 2017 were 1.23, 1.22, and 1.21, respectively (Figure 1). In 2017, the DID value of oral AMU in outpatient settings was 1.19 (98.4%), comprising cephalosporins (0.76, 63.6%), macrolides (0.23, 18.9%), penicillins (0.12, 10.2%), and quinolones (0.07, 5.5%). DID values of oral AMU in outpatient settings were compared for in-house (0.89, 74.4%) and outside (0.31, 25.6%) prescriptions; in-house resulted in a higher proportion of oral cephalosporins (0.60, 66.9% vs. 0.17, 54.1%), but a lower proportion of oral penicillins (0.08, 9.0% vs. 0.04, 13.8%) (Table 1).

Conclusion

Oral AMU in outpatient settings comprised the highest proportion of antibiotic prescribing by dentists in Japan (98.4%). Oral cephalosporins, the predominant drug type and thought to result from inappropriate prescribing in general, were more frequently prescribed in-house than outside. To tackle AMR, further studies are needed to determine the patient and dentist characteristics encouraging cephalosporin prescription.

Disclosures

All authors: No reported disclosures.
1003. Impact of a Standardized Pharmacist-led Β-lactam Allergy Interview on the Quality of Allergy Documentation
Authors: Nguyen Cynthia T , Sahbani Oumaima , Pisano Jennifer , Pursell Ken , Pettit Natasha N
Published: July 2020

Background

Reported β-lactam allergies are common and are associated with inappropriate antibiotic therapy, poor clinical outcomes, and increased hospital costs. Documentation of β-lactam reactions is often incomplete and many patients with a reported allergy can tolerate a β-lactam antibiotic. This study aims to evaluate the impact of a standardized interviewing tool used by pharmacists on the quality of β-lactam allergy documentation.

Methods

This is a single-center, prospective, quasi-experimental study of adult inpatients. Patients were included if they had a documented β-lactam allergy, were interviewed by a pharmacist utilizing a standardized tool, and had the β-lactam allergy updated in the electronic medical record. The primary outcome was the percentage of patients with a complete allergy history documented. A complete allergy history was defined as including a description of the type of reaction, time of the reaction, and timing of the reaction. Secondary endpoints included the documentation of individual allergy history components, including if interventions were required to manage the reaction, tolerance of other β-lactams and receipt of penicillin skin testing in the past. A subgroup analysis was also performed among patients who received antibiotics during the admission evaluating antibiotic use, length of stay, mortality, and readmission.

Results

The study included 107 patients. The average time to complete an interview was 14.8 minutes. After the interview, 11 (10%) patients had the β-lactam allergy label removed. Consequently 107 allergy labels were evaluated in the pre-interview arm and 96 allergy labels in the post-interview arm. More patients had a documented complete allergy history after pharmacist intervention (39% vs. 0%, P < 0.001). Documentation of all components of the allergy history improved after the interview (Table 1). Additionally, the amount of patients with an unknown reaction significantly declined (21% vs. 6%, P = 0.004).

Conclusion

The use of a standardized β-lactam allergy interview tool improved the quality of allergy documentation, led to de-labeling of β-lactam allergies, and reduced the amount of unknown reactions.

Disclosures

All authors: No reported disclosures.
Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms
Authors: Raper Daniel M S , Rutledge Caleb , Winkler Ethan A , Abla Adib A
Published: July 2020

BACKGROUND

The extent of obliteration of ruptured intracranial aneurysms treated with coil embolization has been correlated with the risk of rerupture. However, many practitioners consider that a small neck remnant is unlikely to result in significant risk after coiling.

OBJECTIVE

To report our recent experience with ruptured anterior cerebral artery aneurysms treated with endovascular coiling, which recurred or reruptured, requiring microsurgical clipping for subsequent treatment.

METHODS

Retrospective review of patients with intracranial aneurysms treated at our institution since August 2018. Patient and aneurysm characteristics, initial and subsequent treatment approaches, and outcomes were reviewed.

RESULTS

Six patients were included. Out of those 6 patients, 5 patients had anterior communicating artery aneurysms, and 1 patient had a pericallosal aneurysm. All initially presented with subarachnoid hemorrhage (SAH) and were treated with coiling. Recurrence occurred at a median of 7.5 mo. In 2 cases, retreatment was initially performed with repeat endovascular coiling, but further recurrence was observed. Rerupture from the residual or recurrent aneurysm occurred in 3 cases. In 2 cases, the aneurysm dome recurred; in 1 case, rerupture occurred from the neck. All 6 patients underwent treatment with microsurgical clipping. Follow-up catheter angiography demonstrated a complete occlusion of the aneurysm in all cases with the preservation of the parent vessel.

CONCLUSION

Anterior cerebral artery aneurysms may recur after endovascular treatment, and even small neck remnants present a risk of rerupture after an initial SAH. Complete treatment requires a complete exclusion of the aneurysm from the circulation. Even in cases that have been previously coiled, microsurgical clipping can represent a safe and effective treatment option.
Optic Nerve Decompression from Coil Mass Impingement and Adhesion Following Large Internal Cerebral Artery Aneurysm Coil Embolization: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: July 2020

Aneurysmal mass effect is a consideration for treatment modality selection, particularly in the setting of cranial neuropathy or obstructive hydrocephalus. However, the extent of consequences related to mass effect is not always apparent periprocedurally from the original treatment. This unique video highlights a patient who underwent previous coil occlusion of a supraclinoid internal carotid artery (ICA) aneurysm with subsequent occlusion of the ipsilateral ICA who presented 16 yr later with progressive worsening hemianopsia. The preoperative imaging was suggestive of coil mass impingement prompting operative intervention for decompression. Intraoperative inspection demonstrated that the coil mass was exerting mass effect on the optic nerve and had partially migrated out of the aneurysm dome into the optic nerve. The ICA was also transected and mobilized to further reduce mass effect. Careful microsurgical decompression was achieved and prevented further visual compromise. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Fiduciary management and fiduciary ownership in the post-Soviet countries: experience of Ukraine, Republic of Moldova, Republic of Belarus and Russian Federation
Authors: Nekit Kateryna , Zubar Volodymyr
Published: July 2020

The focus of this research is to define the common and distinctive features of the approaches used by lawmakers in the post-Soviet states (Ukraine, Republic of Moldova, Republic of Belarus and Russian Federation) for the purpose of implementing fiduciary management and fiduciary ownership institutes into their respective national laws. It has been established that over the course of the fiduciary management and fiduciary ownership institutes development in the countries referenced above, similar solutions were initially applied. Thus, an effort was made to implement the institute of trust inherent in the common-law countries into the systems of civil law. However, the effort did not come to fruition and that resulted in the fiduciary management institute being implemented. However, notwithstanding the similarities in the general approaches to determining the content of the fiduciary management provisions in all post-Soviet countries, the situation in Ukraine came out to be different from that in other countries. Following the adoption of the Civil Code (CC) of Ukraine with the fiduciary management institute enshrined therein, the Code was amended by adding the provisions on fiduciary ownership, but typical for the Civil Law countries. Over a long period of time, the Ukrainian legislation was the only one that referred to the institute of fiduciary ownership (fiducia), but due to recent dramatic overhaul, the CC of the Republic of Moldova was amended by the provisions on fiducia as well. This research represents a review of modern statutory provisions of Ukraine, Republic of Moldova, Republic of Belarus and Russian Federation covering fiduciary management and fiduciary ownership, including identification of common and distinguishing features thereof. It is found that as of today, the laws of the Russian Federation and Republic of Belarus do not go beyond fiduciary management, whereas those existing in the Republic of Moldova and Ukraine refer to both fiduciary management and fiducia institutes. Outlined in the research are differences between fiduciary management, trust and fiducia. The research also offers an insight into the degree of influence the Draft Common Frame of Reference and provisions of the CC of Romania and CC of France, those related to trust and fiducia, had on the formation of fiduciary ownership concept in the legislation of the Republic of Moldova. Also included in the research is the analysis of the latest changes in the legislation of Ukraine, related to the introduction of fiduciary ownership as a means to secure the performance of obligations.
Boarding of Critically Ill Patients in the Emergency Department
Authors: Mohr Nicholas M. , Wessman Brian T. , Bassin Benjamin , Elie-Turenne Marie-Carmelle , Ellender Timothy , Emlet Lillian L. , Ginsberg Zachary , Gunnerson Kyle , Jones Kevin M. , Kram Bridgette , Marcolini Evie , Rudy Susanna
Published: July 2020

Objectives:

Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes.

Data Sources and Study Selection:

Review article.

Data Extraction and Data Synthesis:

Emergency department–based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department-based interventions, hospital-based interventions, and emergency department–based resuscitation care units.

Conclusions:

Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department–based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.
The Surviving Sepsis Campaign: Basic/Translational Science Research Priorities*
Authors: Deutschman Clifford S. , Hellman Judith , Ferrer Roca Ricard , De Backer Daniel , Coopersmith Craig M. ,   for the Research Committee of the Surviving Sepsis Campaign
Published: July 2020

Objectives:

Expound upon priorities for basic/translational science identified in a recent paper by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.

Data Sources:

Original paper, search of the literature.

Study Selection:

By several members of the original task force with specific expertise in basic/translational science.

Data Extraction:

None.

Data Synthesis:

None.

Conclusions:

In the first of a series of follow-up reports to the original paper, several members of the original task force with specific expertise provided a more in-depth analysis of the five identified priorities directly related to basic/translational science. This analysis expounds on what is known about the question and what was identified as priorities for ongoing research. It is hoped that this analysis will aid the development of future research initiatives.
Toenail metal concentrations and age at menopause
Authors: White Alexandra J. , O’Brien Katie M. , Niehoff Nicole M. , Jackson Brian P. , Karagas Margaret R. , Weinberg Clarice R. , Keil Alexander P.
Published: July 2020

Background:

Menopause timing is related to cancer, cardiovascular disease, and mortality. Lead has been associated with an earlier age at menopause, but no study has considered exposure to other metals or multiple metals simultaneously.

Methods:

At baseline, we measured toenail concentrations of 16 metals for 903 premenopausal women in the Sister Study (2003–2009). Age at menopause was ascertained through follow-up questionnaires. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between individual metals and age at menopause. We used quantile-g-computation to examine the association between age at menopause and the joint effect of a simultaneous increase in (1) all metals and for subgroups of metals categorized as (2) essential or (3) non-essential.

Results:

For individual metals, we observed negligible associations except for an interquartile range increase in lead which was modestly associated with an earlier age at menopause (HR = 1.03, 95% CI = 1.01, 1.05). In the mixture analyses, a quartile increase in all metals was associated with a later age at menopause (HR = 0.81, 95% CI = 0.64, 1.02). The metals with the largest negative contributions (i.e., associated with a later age at menopause) were chromium and nickel. The joint effect for the essential metals remained inverse (HR = 0.83, 95% CI = 0.64, 1.07), but was attenuated for nonessential metals (HR = 0.98, 95% CI = 0.76, 1.24).

Conclusions:

Although no individual metal was strongly associated with age at menopause, our joint effect analysis suggests that having low levels of essential metals could be associated with an earlier age at menopause.
Prevalence and correlates of overweight and abdominal adiposity amongst adults residing in Madeira Autonomous Region: a cross-sectional, population-based study
Authors: da Costa Liliane P. , Henriques Eva S.A. , Gouveia Teresa P.E.
Published: July 2020

Background:

Data on nutritional status and its risk factors amongst the adult population of the Madeira Autonomous Region (RAM) is scarce. This study aims to investigate the prevalence of, and risk factors associated with overweight and abdominal adiposity, assessed through measuring body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) indexes.

Methods:

Cross-sectional study using a representative sample of 911 subjects (18–64 years) from the RAM Dietary Habits of Adult Population Study. Logistic regression models were conducted to investigate the association between body mass index, WC, and WHtR indexes, with sociodemographic and lifestyle characteristics.

Results:

The prevalence of overweight amongst adults was 60.0% [95% confidence interval (CI): 56.8–63.2]. The prevalence of abdominal adiposity, assessed by WC and WHtR indexes, was 62.6% (95% CI: 59.4–65.7) and 71.9% (95% CI: 69.0–74.8), respectively. In adjusted models, age and self-reported chronic diseases were associated with both overweight and abdominal adiposity. Women were less likely to be overweight [odds ratio (OR) = 0.7 (95% CI: 0.5–0.9); P = .012] but more likely to have increased WC [OR = 2.9 (95% CI: 2.1–4.0); P < .001], compared to men. Being married was positively associated to being overweight [OR = 1.5 (95% CI: 1.1–2.1); P = .013] and increased WC [OR = 1.8 (95% CI: 1.3–2.6); P < .001], but not with WHtR index. Education level was only associated with WHtR index. Inverse associations were found for each abdominal obesity indicators and smoking status.

Conclusions:

Overweight and abdominal adiposity should be considered 2 major public health problems, amongst adult population of the RAM. Older less educated adults, with smoking habits may be considered a target group for health promotion interventions.
Association of long-chain non-coding RNA MHRT gene single nucleotide polymorphism with risk and prognosis of chronic heart failure
Authors: Zhang Gao , Dou Liping , Chen Yuanyuan
Published: July 2020

Long-chain non-coding RNA (lncRNA) Myosin Heavy Chain Associated RNA Transcripts (MHRT) are newly identified cardioprotective lncRNAs. In this study, we investigated the association of MHRT gene single nucleotide polymorphisms with risk and prognosis of chronic heart failure (CHF).

Sanger sequencing was performed to detect the genotypes of rs3729830, rs7140721, rs76614781, rs3729829, rs3729828, rs3729825, and rs3729822 loci in the non-coding region of the MHRT gene from 240 patients with CHF and 240 control subjects. After 3 years of follow-up, progression-free survival was recorded in patients with CHF.

The risk of CHF in subjects carrying A allele of the MHRT gene rs7140721 locus was 1.43 times higher than that of C allele carriers (95% CI: 1.23–1.62, P < .001). The risk of CHF in subjects carrying A allele of the rs3729829 locus was 1.41 times higher than that of G allele carriers (95% CI: 1.20–1.61, P < .01). The risk of CHF in the carriers of T allele of the rs3729825 locus was 1.89 times higher than that of C allele carriers (adjusted OR = 1.89, 95% CI: 1.66–2.04, P < .01). Further, the level of lncRNA MHRT in the plasma of subjects carrying CA/AA genotype of the rs7140721 locus was significantly higher than that of subjects carrying the CC genotype. The level of lncRNA MHRT in the plasma of subjects carrying GA/AA genotype of the rs3729829 locus was significantly higher than that of subjects carrying the GG genotype. In addition, the level of lncRNA MHRT in subjects with CT/TT genotype of the rs3729825 locus carriers was significantly higher than that in subjects with the CC genotype (P < .05). In addition, significant differences in the mortality of patients with CHF were observed between different genotypes of rs7140721, rs3729829, and rs3729825 loci (P < .001).

The single nucleotide polymorphisms of MHRT gene rs7140721, rs3729829, and rs3729825 loci were associated with the risk of CHF and prognosis.
Tongue diagnosis indices for gastroesophageal reflux disease
Authors: Wu Tzu-Chan , Lu Cheng-Nan , Hu Wen-Long , Wu Keng-Liang , Chiang John Y. , Sheen Jer-Ming , Hung Yu-Chiang
Published: July 2020

Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.

We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.

Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen–stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen–stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen–stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen–stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.

The amount of saliva and tongue fur in the spleen–stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.

Trial registration: NCT03258216, registered August 23, 2017.
CYP2C19, PON1, and ABCB1 gene polymorphisms in Han and Uygur populations with coronary artery disease in Northwestern Xinjiang, China, From 2014 Through 2019
Authors: Wang Tingting , Zhao Ting , Bao Sichen , Jia Li , Feng Jie , Yu Aiping , Sun Li , Guo Xihong , Li Hongjian , Yu Luhai
Published: July 2020

The morbidity of coronary artery disease (CAD) in the Uygur population of Xinjiang was much higher than the national average. Clopidogrel is the most commonly used medication worldwide in dual antiplatelet therapy for CAD, and the response of clopidogrel is affected by CYP2C19, PON1, and ABCB1 genetic polymorphisms. The distribution of CYP2C19∗17, ABCB1, and PON1 genetic polymorphisms in Han and Uygur populations with CAD of Xinjiang has not been investigated.

This study aimed to investigate the frequencies of CYP2C19, PON1, and ABCB1 genetic polymorphisms, and to identify the metabolizer phenotype of CYP2C19 in Han and Uygur populations with CAD in Northwestern Xinjiang, China. We identified 602 Han and 527 Uygur patients from 2014 through 2019 and studied genotypes for selected allele polymorphisms using sequencing by hybridization.

There were significantly different allele frequencies and genotype frequencies between the 2 ethnic groups in terms of CYP2C19∗2, ∗3, ∗17, ABCB1 and PON1, (P < .05). For CYP2C19∗17, the frequency of TT genotype was 2.5% in Uygur patients, but it was undetectable in Han patients. In both the intermediate and poor metabolizer groups, the genotypes polymorphisms CYP2C19∗2, ∗3, ∗17 were significantly less common in Uygur patients than in Han patients (P < .001). By contrast, the proportion of ultra-metabolizers as defined by CYP2C19∗2, ∗3, ∗17 polymorphisms significantly higher in Uygur patients (18.6%) than in Han patients (1.7%, P < .001). The CYP2C19∗2 frequency was significantly different between Han patients and Han healthy groups (P < .001), while the CYP2C19∗3 frequency was significantly different between Uygur patients and Uygur healthy groups (P < .001).

Our study supports the notion of interethnic differences in terms of CYP2C19, PON1, and ABCB1 polymorphisms and CYP2C19 genotype-defined clopidogrel metabolic groups. These finding could provide valuable data and insights into personalized CAD treatment for the Uygur and Han populations in Xinjiang.
Multiple cavernous hemangiomas in the orbit
Authors: Deng Chaohua , Hu Weikun
Published: July 2020

Rational:

Cavernous hemangiomas are one of the most common benign primary orbital lesions. These tumors are insidious in onset, slowly progressive and present more often in middle aged women. Multiple orbital cavernous hemangiomas are extremely rare, and only a few cases have been reported in the published literature.

Patient concerns:

Here, we report the diagnosis and treatment of multiple cavernous hemangiomas in the right orbit of a female patient with impaired visual acuity and proptosis of the eye for more than 10 years.

Diagnosis:

Magnetic resonance imaging of the orbit showed a giant and irregular soft mass filling the intraconal and extraconal space of the right orbit, compressing the right optic nerve. After tumor resection, histopathological examination confirmed the diagnosis of cavernous hemangioma.

Interventions:

A lateral orbitotomy was performed and a total of 13 tumors were excised, with the largest tumor measuring approximately 2.5 × 3.0 cm.

Outcomes:

The visual acuity of the patient was preserved, with only a slightly dilated pupil of the right eye. The follow-up period was 6 months with no signs of recurrence.

Lessons:

Multiple cavernous hemangiomas in the orbit is rare and should be excised surgically as soon as possible.
A comprehensive evaluation of single nucleotide polymorphisms associated with atrophic gastritis risk
Authors: Tang Zhen-Yu , Ye Zhuo-Miao , Zheng Jing-Hui , Jiang Feng , Tang You-Ming
Published: July 2020

Background:

Single nucleotide polymorphisms (SNPs) have been inconsistently associated with atrophic gastritis (AG) risk. This meta-analysis aimed to synthesize relevant data on SNPs associated with AG.

Methods:

To identify all associated studies of SNPs and AG published, databases had been searched through January 2020 from the databases of PubMed, China National Knowledge Infrastructure (CNKI), Web of Science, Embase, the Chinese Science and Technology Periodical Database (VIP), Cochrane Library, and Wanfang databases. With the help of network meta-analysis and Thakkinstian algorithm, the best genetic model with the strongest correlation with AG was selected, the final result – matching to the noteworthy correlation – was obtained by referring to the false positive reporting rate (false positive report probability, FPRP). Based on STREGA's stated criteria, the methodological quality of the data we collected was valued. Both Stata 14.0 and GeMTC will be used for a comprehensive review of the system and will be used in our meta-analysis.

Results:

This study will provide a high-quality evidence to find the SNP most associated with AG susceptibility and the best genetic model.

Conclusions:

This study will explore which SNP is most associated with AG susceptibility.

Registration:

INPLASY202050016.
Clinical efficacy and safety of Chinese herbal medicine for the treatment of patients with early diabetic nephropathy
Authors: Yang Xiaomei , Hu Chenling , Wang Shengju , Chen Qiu
Published: July 2020

Background:

Diabetic nephropathy (DN) is among the common and serious complications of diabetes and is also a major cause of end-stage kidney disease. Early DN is also called diabetic microalbumin period, the main treatment is in the control of blood sugar on the basis of kidney protection and urine lowering protein. There are few effective methods of western medicine treatment, and most of them are accompanied by adverse reactions. But some studies have shown that traditional Chinese medicine has achieved the curative effect and has certain superiority. However, there are few systematic reviews on the treatment of traditional Chinese herbal medicine for early DN currently. Therefore, this study conducted a systematic review of clinical efficacy and safety of Chinese herbal medicine for the treatment of patients with early DN, aim to comprehensively analyze the role of traditional Chinese herbal medicine in the treatment of early DN.

Methods and analysis:

The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-4-0139/) and INPLASY registration number is INPLASY202040139. A systematic literature search will be conducted in 3 English database and 4 Chinese databases with a language limitation of English and Chinese. Search for clinical research literature on Chinese herbal medicine treatment of DN published in domestic and foreign biomedical journals. The time is limited from January 2010 to February 2020. We will investigate heterogeneity across studies and publication bias. To assess the risk of bias and quality of the included studies, we will use the Cochrane Collaboration's ROB tool. According to the relevant standards in the Cochrane Intervention System Evaluation Manual, it will be divided into low risk, high risk, and unclear. We will also use the RevMan 5.3 software and Stata 13.0 software for meta-analysis of the effectiveness and symptom scores of DN proteinuria.

Ethics and dissemination:

The ethical considerations are not required because the systematic review is based on published studies. The systematic review and meta-analysis will be published in a peer-reviewed Journal.
Normotensive hypokalemic primary hyperaldosteronism mimicking clinical features of anorexia nervosa in a young patient
Authors: Huang Yen-Chu , Tsai Ming-Hsien , Fang Yu-Wei , Tu Mei-Lan
Published: July 2020

Rationale:

The typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure, and potassium deficiency. However, normotensive PA is rare. Therefore, an atypical presentation of normal blood pressure is a challenge for the diagnosis and treatment of PA.

Patient concerns:

A 43-year-old, thin, and tall woman (body mass index, 18.6 kg/m2) with generalized weakness for 1 day presented to our emergency department, where hypokalemia was a significant finding. The initial diagnosis was anorexia nervosa with the evidence of renal potassium wasting with low urinary sodium and chloride levels, metabolic alkalosis, normal blood pressure, and low body mass index. However, neither vomiting features nor other specific induced vomiting features were noted.

Diagnoses:

The laboratory examination revealed high plasma aldosterone level, low plasma renin activity, and extremely high aldosterone-to-renin ratio indicating the diagnosis of PA, confirmed via adrenal computed tomography.

Interventions:

Surgical adrenalectomy was performed. Pathological diagnosis was a benign cortical adenoma.

Outcomes:

Patient's serum potassium level and hormonal status became normalized after surgical removal of adrenal adenoma. She fully recovered without any further sequelae.

Lessons:

It is too early to rule out PA based on the presence of normal blood pressure in a patient with metabolic alkalosis and renal wasting hypokalemia. Moreover, PA should be considered in a normotensive patient with an unknown hypokalemic etiology to avoid delayed diagnosis and treatment.
Myofibroblast phagocytic cutaneous mucinosis: phagocytosis of mucinous substances by myofibroblasts in a distinctive cutaneous mucinosis
Authors: Nakaya Takeo , Kamiya Koji , Nakaya Michio , Tsuji Kentaro , Niki Toshiro , Ohtsuki Mamitaro , Tanaka Akira
Published: July 2020

Rationale:

Phagocytosis is an important physiological process for eliminating unnecessary substances or dead cells after tissue damage, such as inflammation or infarction. Phagocytosis was previously considered to be mainly performed by professional phagocytotic cells, such as macrophages. In contrast, we previously demonstrated that the phagocytosis of dead cells and unnecessary substances by myofibroblasts is as important as that by professional phagocytotic cells in myocardial infarction. Based on our discovery, we speculated that phagocytosis by myofibroblasts may be a more common pathological phenomenon also in other diseases than previously believed.

Patient concerns:

A 44-year-old male patient with atopic dermatitis developed a cutaneous reddish nodule with an underlying induration on his thigh.

Interventions:

The cutaneous lesion was surgically removed.

Diagnoses:

Histopathological examination demonstrated that the cutaneous lesion had solid infiltration by inflammatory cells, namely, plasma cells, histiocytes, and lymphocytes, in the dermis. The cutaneous lesion included mucinosis in the dermis. Inside the mucinosis, we detected cells with clear areas of mucinous substances. Some of the cells were α-smooth muscle actin-positive myofibroblasts. Electron microscopic images demonstrated that there were collagen bands in the cells with mucinous engulfment. Based on these pieces of evidence, we conclude that these mucinous phagocytotic cells were myofibroblasts, not professional phagocytotic cells, such as macrophages.

Outcomes:

There was no recurrence of the lesion.

Lessons:

The clinical appearance of this case resembled that of previously reported solitary cutaneous focal mucinoses. However, our case had distinctive characteristics, such as the phagocytosis of mucinous substances by myofibroblasts, multiple mucinous lesions in a single eruption, and the presence of inflammatory cells, which have not been previously reported. For this distinct cutaneous lesion, a clear dermatological and pathological name has yet to be determined. We propose “myofibroblast phagocytic cutaneous mucinosis” as a candidate name. In addition, our discoveries suggest that phagocytosis by myofibroblasts is not rare but rather is a common pathological phenomenon that has been undetected or unrecognized.
Value of ultrasonography in the diagnosis of carpal tunnel syndrome—a new ultrasonographic index in carpal tunnel syndrome diagnosis
Authors: Perţea Mihaela , Ursu Sergiu , Veliceasa Bogdan , Grosu Oxana-Mădălina , Velenciuc Natalia , Luncă Sorinel
Published: July 2020

We analyze the effectiveness of ultrasonography in diagnosing carpal tunnel syndrome (CTS) and propose the use of sonographic index of median nerve (MN) in carpal tunnel (SIMNCT) in a diagnostic algorithm and in establishing a scale of severity.

We studied a group of 344 patients with CTS symptoms, examining them by ultrasound. We measured in all patients, on the affected hand: the size of the cross-sectional area of the MN at carpal tunnel (CT) inlet and outlet, nerve morphology at passage through CT, the vertical thickness of the MN entering into the CT – G1, the lowest vertical thickness into the CT or leaving the CT – G2, the thickness of the MN in the transversal plane as entering in the CT – L. Normal values were considered the similar measurements taken on the healthy hand and we established as normal SIMNCT = 16%. We proposed the formula SIMNCT = 100% (1-G2/G1) in order to calculate the index.

Statistics show a significant sensitivity of SIMNCT (P < .0001) compared with cross-sectional area (CSA) and flattening ratio in the diagnosis of CTS. Analyzing the SIMNCT developed by us, we demonstrated a sensitivity of 94.81% and a specificity of 99.66% in CTS diagnosis. Thereby, we propose a CTS severity classification: normal = 16%, mild = 16–19%, moderate = 19% to 28%, severe = 28% to 50%, very severe > 50%.

Ultrasonography is an effective method of studying the morphology of the tunnel and compressed nerve at various CTS stages and determining the cause of compression. The SIMNCT is a valuable and practical indicator and it can be used in the CTS diagnosis.
Trans-catheter arterial chemoembolization plus Sorafenib, an unsuccessful therapy in the treatment of hepatocellular carcinoma?
Authors: Zhang Tao , Huang Weisen , Dong Haorong , Chen Yijun
Published: July 2020

Background:

Trans-catheter arterial chemoembolization (TACE) plus Sorafenib is recommended as one of the primary means for treating hepatocellular carcinoma (HCC). This updated meta-analysis focuses on identifying the efficacy and safety of TACE plus Sorafenib versus TACE, which remains controversial despite years of exploration.

Method:

PubMed, Medline, Embase, China Journal Full-text Database, Wanfang Database, and Weipu Database were used to retrieve the studies which are about comparing the clinical efficacy and safety of TACE+Sorafenib with TACE alone. The Review Manager (Version 5. 3) software was used to perform a meta-analysis of the results of studies which met the inclusion criteria recommended by the Cochrane Collaboration.

Result:

Compared with TACE for treating primary HCC, TACE combined with Sorafenib can improve the 1 year, 2 years, 3 years, and 5 years overall survival rate (OS) of patients, respectively, and also improve disease control rate (DCR) and objective response rate (ORR). In terms of adverse reactions, the treatment group can lead to more complications significantly, such as hand-foot skin reaction, hypertension, diarrhea, rash, hair loss, and so on, most of which are relevant to Sorafenib related adverse reactions, but most patients have a good prognosis after symptomatic treatment.

Conclusion:

The clinical efficacy of TACE combined with Sorafenib in treating primary hepatocellular carcinoma is better than TACE, and the safety is acceptable.
Posterior vertebral column resection for correction of thoracolumbar kyphosis after failed anterior instrumented fusion
Authors: Lu Jian , Dai Zhe-Hao , Li Hai-Sheng , Kang Yi-Jun , Chen Fei
Published: July 2020

To explore the effectiveness of posterior vertebral column resection for failed thoracolumbar anterior instrumented fusion.

Ten patients with anterior fusion with refractory pain, progressive neurological deficits, and kyphosis were recruited. Anterior removal of the implant and posterior vertebral column resection were performed. The mean operating time, intraoperative blood loss, kyphosis angle, visual analog scale pain score, Oswestry disability index, bone fusion time, and complications were assessed in a minimum 18-month follow-up.

The mean operating time was 323.5 ± 63.6 minutes, with a mean blood loss of 1189 ± 253.4 mL. The mean preoperative kyphosis angle of 54.6° ± 8.0° immediately decreased to 4.8° ± 1.5° after revision surgery and eventually to 6.8° ± 1.3° at the final follow-up. The mean bone fusion time was 6.8 ± 1.2 months. All patients had satisfactory sagittal and coronal balance with no implant failure at the last follow-up. The average visual analog scale score was 6.2 ± 1.0 preoperatively, and it decreased to 2.6 ± 0.5 at the last follow-up. No patient suffered from neurological deterioration. The Oswestry disability index decreased from 39.8% ± 4.6% preoperatively to 24.5% ± 4.7% at the final follow-up. Complications occurred in 4 patients: 3 experienced tearing of the lung, and 1 had a superficial wound infection.

Anterior removal of the implant and posterior vertebral column resection constituted a safe and effective revision surgery for patients with prior anterior fusion with rigid postsurgical deformities.
Enhanced recovery after surgery on multiple clinical outcomes
Authors: Zhang Xingxia , Yang Jie , Chen Xinrong , Du Liang , Li Ka , Zhou Yong
Published: July 2020

Background:

Previously, many meta-analyses have reported the impact of enhanced recovery after surgery (ERAS) programs on many surgical specialties.

Objectives:

To systematically assess the effects of ERAS pathways on multiple clinical outcomes in surgery.

Design:

An umbrella review of meta-analyses.

Date sources:

PubMed, Embase, Web of Science and the Cochrane Library.

Results:

The umbrella review identified 23 meta-analyses of interventional study and observational study. Consistent and robust evidence shown that the ERAS programs can significantly reduce the length of hospital stay (MD: −2.349 days; 95%CI: −2.740 to −1.958) and costs (MD: −$639.064; 95%CI:: −933.850 to −344.278) in all the surgery patients included in the review compared with traditional perioperative care. The ERAS programs would not increase mortality in all surgeries and can even reduce 30-days mortality rate (OR: 0.40; 95%CI: 0.23 to 0.67) in orthopedic surgery. Meanwhile, it also would not increase morbidity except laparoscopic gastric cancer surgery (RR: 1.49; 95%CI: 1.04 to 2.13). Moreover, readmission rate was increased in open gastric cancer surgery (RR: 1.92; 95%CI: 1.00 to 3.67).

Conclusion:

The ERAS programs are considered to be safe and efficient in surgery patients. However, precaution is necessary for gastric cancer surgery.