bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain structure, psychosocial, and physical health in acute and chronic back pain: a UK Biobank study
Authors: Tagliaferri Scott D. , Fitzgibbon Bernadette M. , Owen Patrick J. , Miller Clint T. , Bowe Steven J. , Belavy Daniel L.
Published: October 2021

Brain structure, psychosocial, and physical factors underpin back pain conditions; however, less is known about how these factors differ based on pain duration and location. We examined, cross-sectionally, 11,106 individuals from the UK Biobank who (1) were pain-free (n = 5616), (2) had acute back pain (n = 1746), (3) had chronic localised back pain (CBP; n = 1872), or (4) had chronic back pain and additional chronic pain sites (CWP; n = 1872). We found differences in structural brain measures in the chronic pain groups alone. Both CBP and CWP groups had lower primary somatosensory cortex {CBP mean difference (MD) (95% confidence interval [CI]): −250 (−393, −107) mm3, P < 0.001; CWP: −170 (−313, −27)mm3, P = 0.011} and higher caudate gray matter volumes (CBP: 127 [38,216]mm3, P = 0.001; CWP: 122 [33,210]mm3, P = 0.002) compared with pain-free controls. The CBP group also had a lower primary motor cortex volume (−215 [−382, −50]mm3, P = 0.005), whereas the CWP group had a lower amygdala gray matter volume (−27 [−52, −3]mm3, P = 0.021) compared with pain-free controls. Differences in gray matter volumes in some regions may be moderated by sex and body mass index. Psychosocial factors and body mass index differed between all groups and affected those with widespread pain the most (all, P < 0.001), whereas grip strength was only compromised in individuals with widespread pain (−1.0 [−1.4, −0.5] kg, P < 0.001) compared with pain-free controls. Longitudinal research is necessary to confirm these interactions to determine the process of pain development in relation to assessed variables and covariates. However, our results suggest that categorised pain duration and the number of pain sites warrant consideration when assessing markers of brain structure, psychosocial, and physical health.
Antipsychotic-Associated Weight Gain and Clinical Improvement Under Clozapine Treatment
Authors: Garriga Marina , Mallorquí Andrea , Bernad Sonia , Ruiz-Cortes Victoria , Oliveira Cristina , Amoretti Silvia , Mezquida Gisela , Bioque Miquel , Molina Oriol , Gómez-Ramiro Marta , Vieta Eduard , Bernardo Miquel , Parellada Eduard , García-Rizo Clemente
Published: October 2021

Background

Antipsychotic-associated weight gain is a common adverse effect with several negative outcomes in the clinical evolution of patients, which might also affect patients' self-identity from physical appearance and imply treatment discontinuation. However, recent research has drawn attention to an unexpected clinical improvement associated with weight gain, mostly in patients under treatment with clozapine or olanzapine.

Methods

Twenty-three treatment-resistant psychosis patients initiating clozapine were evaluated. Longitudinal psychopathological assessment through the Positive and Negative Syndrome Scale (PANSS) and anthropometric evaluation were performed at baseline, week 8, and 18.

Results

Body mass index (BMI) change during clozapine treatment was associated with clinical improvement measured with PANSS total score at week 8 (P = 0.021) while showed a trend at week 18 (P = 0.058). The PANSS general score was also associated with weight gain at week 8 (P = 0.022), whereas negative subscale score showed a trend at week 8 (P = 0.088) and was associated between week 8 and 18 (P = 0.018). Sex differences applied at week 8 for PANSS total score, where clinical improvement was significantly associated with BMI in male subjects (P = 0.024). We also stratified for time to initiate clozapine, finding significant associations in negative symptom at week 8 (P = 0.023) and week 18 (P = 0.003) for subjects, which started clozapine after 3 years of illness.

Conclusions

Our results suggest that in subjects initiating clozapine, clinical improvement is associated with BMI increase, mostly in negative symptom and in patients after 3 years of antipsychotic use. Our findings were already described in the preantipsychotic era, suggesting some pathophysiological mechanism underlying both conditions.
Assessment of Serum Vitamin D Levels in Children With Pityriasis Alba: A Retrospective Study
Authors: Chen Xiao-Yi , Xiao Jing , Ji Xiu-Wai , Gao Hai-Mei , Zhong Lian-Sheng
Published: October 2021

Objective:

This study was performed to analyze the correlation between pityriasis alba (PA) and the serum 25-hydroxyvitamin D status in children.

Methods:

The study population comprised 460 patients with PA and 254 age- and sex-matched healthy controls. The serum level of 25-hydroxyvitamin D was compared between the two groups by student t test.

Results:

The serum level of 25-hydroxyvitamin D was significantly lower in patients with PA than in healthy controls (P < 0.001). There were statistically significant differences in the serum vitamin D status between the PA group and control group (P < 0.001); specifically, patients with PA had a significantly higher frequency of vitamin D deficiency (52.83% vs. 24.35%, P = 0.001) and lower frequency of vitamin D sufficiency (22.83% vs. 37.01%, P < 0.001) than controls. PA patients showed significantly lower serum level of vitamin D than controls in deficient and sufficient groups (P = 0.005 and 0.027, respectively), and in insufficient group, serum vitamin D level was lower in PA patients than in controls, but it showed no statistical difference (P = 0.061).

Conclusion:

Vitamin D may play a role in the pathogenesis of PA. Further investigations are required to establish the relationship between the severity of PA and the vitamin D status and to evaluate the potential for use of vitamin D in the treatment of PA.
Prevalence of Acne Inversa (Hidradenitis Suppurativa) in China: A Nationwide Cross-Sectional Epidemiological Study
Authors: Wang Zhong-Shuai , Li Jing , Ju Qiang , Lai Wei , Geng Song-Mei , Kang Xiao-Jing , Jiang Xian , Jin Hong-Zhong , Xie Hong-Fu , Sun Qing , Li Hang , Li Shan-Shan , Yuan Chen , He Li , Fang Hong , Wang Gang , Tao Juan , Gao Xing-Hua , Wu Yan , Lin You-Kun , Li Yu-Zhen , Gu Jun , Yan Yan , Wang Baoxi
Published: October 2021

Objective:

This study was performed to estimate the prevalence of hidradenitis suppurativa (HS) in China and describe the demographic and clinical features of HS in the Chinese population.

Methods:

This multicenter clinic-based cross-sectional study was conducted in dermatology clinics within 19 hospitals located in 15 cities/provinces across China from September to October 2020. The prevalence of HS was calculated as the percentage of patients with HS among all visitors at participating clinics during the 1-month study period. HS was independently diagnosed by two certified dermatologists at each site. All visitors at participating clinics were screened, and all patients with HS were invited to participate in a questionnaire survey to elucidate the demographics and clinical features of HS in the Chinese population.

Results:

We identified 92 patients with HS among 274,742 visitors at participating clinics. The prevalence rate was 0.03349% or 33.49 per 100,000 population (95% confidence interval, 26.64-40.32), and the female:male ratio was 1.0:4.7.

Conclusion:

The overall prevalence of HS in China was lower than that in Western and other Asian countries with a predominance of male patients.
Transcanal Transvestibular Endoscopic Neurectomy: First Experience
Authors: Marchioni Daniele , Caiazza Nicole , Calabrese Cinzia , Soloperto Davide
Published: October 2021

Objective:

Ménière's disease is an idiopathic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and persistent tinnitus. In 10% to 30% of cases, conservative therapy fails, and Ménière's disease is defined as intractable. In these patients, ablative techniques with unilateral vestibular deafferentation are mandatory. Several approaches for vestibular neurectomy, which preserve hearing capability, are described. In patients presenting severe dizziness associated with high-grade sensorineural hearing loss, surgical labyrinthectomy, or selected vestibular neurectomy through a translabyrinthine approach are the treatments commonly considered. This study reports the first application of transcanal transvestibular endoscopic neurectomy in two patients with frequent disabling vertigo and high-grade sensorineural hypoacusia.

Methods:

This was a retrospective chart review including patients with intractable Ménière's disease who underwent vestibular neurectomy, performed in our ENT department between January 2017 and January 2020, selecting patients with disabling vertigo and high-grade sensorineural hypoacusia. We describe step-by-step the surgical technique of transcanal transvestibular endoscopic neurectomy.

Results:

Overall, two patients underwent transcanal transvestibular endoscopic neurectomy. We performed transcanal transvestibular neurectomy in all cases. No intraoperative complications were observed. On the 2nd postoperative day, one patient presented CSF leak, leading to surgical revision. A complete resolution of vertigo attacks was observed 6 months after surgery.

Conclusion:

Even though this study presents a limited number of cases, transcanal transvestibular neurectomy is a promising, safe, and effective procedure in selected cases.
Durable Left Ventricular Assist Device as a Bridge to Heart Transplantation Under the New Donor Heart Allocation System
Authors: Nordan Taylor , Critsinelis Andre C. , Ortoleva Jamel , Kiernan Michael S. , Vest Amanda , DeNofrio David , Chen Frederick Y. , Couper Gregory S. , Kawabori Masashi
Published: October 2021

The new donor heart allocation system prioritizes candidates supported by temporary devices. However, waitlist and posttransplant outcomes in candidates with durable left ventricular assist device (LVAD) remain to be elucidated. The United Network for Organ Sharing database was queried for adults listed from October 2015 to March 2020 for a single-organ, first-time heart transplant (HTx) with a durable LVAD. Waitlist removal within 1 year because of death or clinical deterioration and HTx was analyzed using competing risks regression. Candidates who underwent HTx within 1 year of listing were identified for examination of post-HTx survival using the Kaplan–Meier method and Cox proportional hazards models. Compared with candidates listed under the old system (n = 2,122), candidates listed under the new system (n = 1,562) were slightly younger (p = 0.04) but had higher body mass index (p < 0.01). Those listed under the new system were significantly less likely to experience waitlist removal because of death or clinical deterioration (subhazard ratio [HR] 0.68, 95% CI 0.52–0.90) but were also less likely to undergo HTx (sub-HR 0.91, 95% CI 0.83–0.998). Those who survived to HTx were more likely to experience death or need for re-HTx within 1 year of HTx under the new system (adjusted HR 1.50, 95% CI 1.11–2.03). Candidates with durable LVAD experience favorable waitlist outcomes under the new allocation system, although those who undergo HTx may be at increased mortality risk. Thus, candidates with a durable LVAD should be carefully selected for HTx listing under the new allocation system.
Effects of Danhong injection on cardiac function and blood lipid in patients with angina pectoris of coronary heart disease
Authors: Liang Jian , He Xiaojiao , Zhou Hongyu , Liang Peng
Published: October 2021

Background:

Angina pectoris of coronary heart disease is the leading cause of death worldwide. Danhong injection is a supplement for angina pectoris of coronary heart disease. A large number of studies have confirmed its efficacy and safety. However, there is no rigorous clinical study to evaluate the effects of Danhong injection on cardiac function and blood lipid in patients with angina pectoris of coronary heart disease.

Methods:

This is a prospective, randomized, double-blind, placebo-controlled trial to study the effects of Danhong injection on cardiac function and lipid profile in patients with angina pectoris of coronary heart disease. Participants will be randomly divided into treatment group and control group. The treatment group will be treated with Danhong injection and the control group will be treated with placebo under basic treatment according to recommended guideline, and followed up for 3 months after 14 consecutive days of treatment. Outcomes include: cardiac function (left ventricular end-diastolic diameter); left ventricular end-systolic diameter; left ventricular ejection fraction, blood lipid levels (total cholesterol; triacylglycerol; low density lipoprotein cholesterol; high density lipoprotein cholesterol), the number of angina attacks per week, total amount of nitroglycerin tablets, and adverse reactions.

Discussion:

This study will evaluate the efficacy of Danhong injection in improving cardiac function and blood lipid in patients with angina pectoris of coronary heart disease. The results of this study will provide reference for clinical use of Danhong injection to improve cardiac function and blood lipid in patients with angina pectoris of coronary heart disease.

Trial registration: OSF Registration number: DOI 10.17605/OSF.IO/TPZJ5.
The relationship between fetuin-A and coronary atherosclerotic heart disease (CHD) and CHD-related risk factors
Authors: Zheng Jianping , Huang Maozhi , Huang Qilei , Chen Qiaoxing , Chen Ziguo
Published: October 2021

Fetuin-A plays an important role in antivascular calcification and inflammatory response, it is necessary to explore the relationship between fetuin-A and coronary atherosclerotic heart disease (CHD) and CHD-related risk factors.

A total of 92 patients with CHD as the research group, and 60 healthy persons as the control group were enrolled from May 2019 to May 2020. Fetuin-A levels were determined by enzyme-linked immunosorbent assay, and the characteristics and clinical data were collected and compared. Logistic regression was used to analyze the factors influencing CHD.

The age, proportion of males, patients with hypertension and diabetes, as well as fetuin-A level in the research group were significantly higher than those in the control group, but the high-density lipoprotein cholesterol level was significantly lower than that in the control group (P < .05). Logistic regression analysis and correction showed that gender, age, blood pressure, and diabetes were related to the onset of CHD, and there was a significant correlation between the level of fetuin-A and age (P < .05).

Serum fetuin-A was related to the onset risk of CHD, and showed a significant correlation with age.
Effect of non-pharmacological interventions on sleep in preterm infants in the neonatal intensive care unit
Authors: Huang Qingchun , Lai Xin , Liao Jianhua , Tan Yingchao
Published: October 2021

Background:

Premature infants are prone to suffer multisystem complications after birth due to the incomplete development of organ tissues and low immunity, and they require a longer period of supervised treatment in the neonatal intensive care unit (NICU). However, due to the specificity of medical care in the NICU, the sleep of preterm infants is highly susceptible that has an impact on the prognosis of preterm infants. Recently, various non-pharmacological interventions have been applied to the sleep of preterm infants in the NICU, which have shown positive outcomes. However, the efficacy and safety of them are unclear. This study aims to evaluate the effects of non-pharmacological interventions on sleep in preterm infants in the NICU through a network meta-analysis.

Methods:

Randomized controlled trials of non-pharmacological interventions on sleep in preterm infants in the NICU published before September 2021 will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science. Two researchers will be independently responsible for screening and selecting eligible literatures, extracting data and evaluating the risk of bias in the included studies. Stata 14.0 software will be used for data analysis.

Results:

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

Conclusion:

This study will provide comprehensive and reliable evidence-based references for the efficacy and safety in different non-pharmacological interventions on sleep in preterm infants in the NICU.
Titanium elastic nailing can be used in 6 to 10 years old pediatric with Delbet IV femoral neck fractures
Authors: Zhu Dongsheng , Xu Xiangfei , Zhang Ming , Wang Tong
Published: October 2021

The purpose of this study was to analyze the outcomes of titanium elastic nail (TEN) for the children in 6 to 10 years old who sustained a Delbet IV femoral neck fracture.

A total of 56 children aged 6 to 10 years old with Delbet IV femoral neck fracture treated with TEN or cannulated screw (SC) were identified at our hospital from January 2009 to December 2019. Of which 24 were treated with TEN, and 32 with SC. All of them were followed up for 1 year after operation, and the differences in operation time, intraoperative blood loss, hospitalization time, hip joint function, and complication between the 2 groups were compared. Harris and Ratliff hip score were used to evaluate the hip function.

All 56 fractures united properly. No major complications were noted in both groups. The intraoperative blood loss and operation time in TEN group and SC group were (11.42 ± 3.41) mL, (19.66 ± 4.05) mL (P = .000) and (33.58 ± 7.89) min, (40.22 ± 7.48) min (P = .002), respectively. There was no significant statistical difference between hip regarding range of motion and femoral neck-shaft angle in both groups, as well as Harris and Ratliff hip score between the 2 groups.

TEN represent safe and effective methods in the treatment of Delbet IV femoral neck fracture in 6 to 10 years old children. TEN internal fixation is a minimal invasive and simpler technique and suitable for young children of Delbet IV femoral neck fracture.
Underwater endoscopic mucosal resection of a follicular lymphoma
Authors: Kim Tae Un , Kim Su Jin , Choi Cheol Woong
Published: October 2021

Introduction:

Endoscopic resection of a follicular lymphoma (FL) presenting as a gastric subepithelial tumor (SET), along with periodic follow up can be a treatment option because gastrointestinal FL cells tend to reside in the primary site, which may explain its indolent nature.

Patient concerns:

A gastric lesion was found incidentally during a screening endoscopy in 73-year-old woman without any gastrointestinal symptom.

Diagnosis:

The patient was diagnosed with a grade I FL that was 1.4 cm large, at the greater curvature of lower-body.

Intervention:

We performed underwater endoscopic mucosal resection (UW-EMR), and there was no serious complication, such as bleeding and perforation.

Outcomes:

Complete en bloc resection was achieved with UW-EMR. Follow-up endoscopic biopsy after 3 months revealed no residual tumor on the resection site.

Conclusion:

UW-EMR may be a simple and safe resection method for gastric FL without metastases, that measure >1 cm.
Lingual thyroid with severe hypothyroidism
Authors: Huang Hsuan , Lin Yi-Hsin
Published: October 2021

Introduction:

Ectopic thyroid tissue presenting at the base of the tongue, called lingual thyroid, is a clinical rarity. Clinical presentation varies depending upon either the severity of regional symptoms associated with the enlargement of gland size, or the features related to thyroid dysfunction.

Patient concerns:

We reported a case of a 29-year-old female who presented with symptoms of easy fatigue and depression for 3 months.

Diagnosis:

After a series of diagnostic workup, the lingual thyroid with severe hypothyroidism was diagnosed.

Intervention and outcome:

She received conservative treatment with thyroid hormone replacement and the symptoms improved significantly.

Lessons:

Lingual thyroid is a rare entity that needs careful diagnostic workup including clinical examination, biochemical tests, imaging methods such as ultrasonography, scintigraphy, computed tomography, magnetic resonance imaging, and fine-needle aspiration cytology to plan the management. Lingual thyroid with hypothyroidism and no neck regional symptoms can be conservatively treated and requires regular follow-up for the prevention of potential risk of malignant transformation.
Post-pregnancy osteoporosis-related multiple vertebral fractures associated with post-partum thyroiditis
Authors: Han Hyeong-Wook , Jeon Na-Mo , Lee Jae-Min , Kim Jae-Hyung
Published: October 2021

Introduction:

Osteoporosis is a condition commonly observed in elderly and postmenopausal women. Pregnancy and lactation-induced osteoporosis are rare, and the development of severe vertebral fractures is uncommon. Postpartum thyroiditis (PPT) is a minor cause of osteoporosis. To the best of our knowledge, the development of osteoporosis associated with pregnancy has not yet been reported.

Patient concerns:

Here, we report a rare case of post-pregnancy osteoporosis-related multiple vertebral fractures associated with PPT. A 25-year-old woman developed lower back pain after her first delivery. She was then admitted to our medical center because of aggravated back pain.

Diagnosis:

On radiographic examination, she had multiple compressions of the lumbar spine. Bone mineral density was associated with osteoporosis. Laboratory tests, thyroid scans, and thyroid ultrasonography were performed. The patient was diagnosed with PPT.

Interventions:

The patient stopped lactating immediately. She was administered bisphosphate at 3 mg/3 months intravenously, elementary calcium at 1000 mg/day, and calcitriol 0.5 μg/day.

Outcomes:

A month later, her pain was relieved by proper management and she could independently walk indoors.

Conclusion:

PPT might play a role in aggravating post-pregnancy osteoporosis. It should be considered as a differential diagnosis in patients presenting with postpartum osteoporosis-related multiple spine fractures.
Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor
Authors: Ren Congcong , Zhao Jing , Kang Lin , Di Yan , Qiu Gang , Wang Qingxue
Published: October 2021

Rationale:

Mediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis.

Patient concerns:

An 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened.

Diagnosis:

Computed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and α-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components.

Interventions:

The patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy.

Outcomes:

The patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects.

Lessons:

The case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs.
Posttraumatic Vernet syndrome without fracture
Authors: Braut Tamara , Maršić Matej , Ravlić Iva , Maržić Diana , Marijić Blažen , Malvić Goran , Vrebac Ilinko , Velepič Marko
Published: October 2021

Rationale:

The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms.

Patient concerns:

A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department.

Diagnoses:

Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis.

Interventions:

Intensive swallowing and speech exercises, assisted by a specialist, were performed.

Outcomes:

Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing.

Lessons:

According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.
Diarrhea in pediatric recipients of solid organ or bone marrow transplants
Authors: Phrommas Jirachart , Tanpowpong Pornthep , Getsuwan Songpon , Lertudomphonwanit Chatmanee , Chantarogh Songkiat , Anurathapan Usanarat , Treepongkaruna Suporn
Published: October 2021

Diarrhea is common in adults after solid organ transplantation (SOT) and bone marrow transplantation (BMT), but data in children are limited. Therefore, we aimed to determine the incidence and etiology of pediatric early-onset diarrhea in post SOT and BMT.

We reviewed children aged 6 months to 18 years who underwent liver transplantation, kidney transplantation or BMT between January 2015 and December 2019 with duration of diarrhea > 72 hours within the first 6 months after transplantation. Clinical data and diarrheal course were collected. Regression analyses were performed to define factors associated with the interested outcomes.

Among 252 transplanted patients, 168 patients (66.6%) had 289 documented episodes of diarrhea. A diagnosis of 68.2% of post-transplant diarrhea remained ‘indefinite’. Enteric infection in SOT and gastrointestinal acute graft-versus-host disease (GI-aGVHD) in BMT were the commonly identified etiologies. Among 182 episodes among BMT children, skin rash was more pronounced when compared the ones with diarrhea > 7 days vs ≤ 7 days (odds ratio [OR] 13.9; 95% CI 1.8, 107.6). Males were more likely to develop GI-aGVHD as compared to females (OR 8.9). We found that GI-aGVHD was more common in the ones with skin rash and the presence of white blood cells in stool examination (OR 8.4 and 3.1, respectively). Deaths occurred in 7.7%.

Two-thirds of post-transplant children experienced at least one episode of early-onset diarrhea, of which the etiology mainly remains undefined. Various clinical factors of prolonged/chronic diarrhea and GI-aGVHD may help clinicians when managing these children.
Effect of the COVID-19 pandemic in stroke code activations in the region of Madrid
Authors: Riera-López Nicolás , Fuentes Blanca , de Donlebún Jorge Rodríguez-Pardo
Published: October 2021

Acute sstroke is the most common time-dependent disease attended in the emergency medical service (EMS) of Madrid (SUMMA 112). Community of Madrid has been one of the most affected regions in Spain by the coronavirus disease 2019 (COVID-19) pandemic. A significant reduction in acute sstroke hospital admissions has been reported during the COVID-19 pandemic compared to the same period 1 year before. As international clinical practice guidelines support those patients with suspected acute stroke should be accessed via EMS, it is important to know whether the pandemic has jeopardized urgent pre-hospital stroke care, the first medical contact for most patients. We aimed to examine the impact of the COVID-19 in stroke codes (SC) in our EMS among 3 periods of time: the COVID-19 period, the same period the year before, and the 2019-2020 seasonal influenza period.

We compared the SC frequency among the periods with high cumulative infection rate (above the median of the series) of the first wave of COVID-19, seasonal influenza, and also with the same period of the year before.One thousand one hundred thirty SC were attended during the 3 periods. No significant reduction in SC was found during the COVID-19 pandemic. The reduction of hospital admissions might be attributable to patients attending the hospital by their means. The maximum SC workload seen during seasonal influenza has not been reached during the pandemic. We detected a nonsignificant deviation from the SC protocol, with a slight increase in hospitals’ transfers to hospitals without stroke units.
Optimal relative workload for managing low-injury risk in lower extremities of female field hockey players
Authors: Kim Taegyu , Park Jong-Chul , Park Jae-Myoung , Choi Hokyung
Published: October 2021

Our study aimed to investigate the relative workload that is related to the injury in lower extremities of female field hockey players and to identify the optimal ratio of acute to chronic workloads (ACWR) depending on the playing position to manage low risk of sports-related injuries.

Data were collected using a global positioning systems unit on a full-time basis and during competition among 52 players who were enrolled in Korea National Team. The ACWR was calculated by dividing the most recent 1 week workload by the prior 4 weeks workload. Injury risk was calculated for each category from very low to very high based on a z-score.

In striker and midfielder, the injury risk was the lowest in the moderate-low category of total distance covered, meters per minute (MpM), repeated high-intensity effort bouts, and acceleration bouts, and the moderate-high category of high-intensity running distance (HID). The injury risk of a defender was the lowest in the moderate-low category of HID and MpM.

The ACWR in total distance covered, MpM, repeated high-intensity effort bouts, and acceleration bouts should stay within the moderate-low category in striker and midfielder positions and HID and MpM in defender positions in order to manage low-risk of non-contact and soft tissue injuries in female field hockey players.
Psychotropic medication prescribing during the COVID-19 pandemic
Authors: Hirschtritt Matthew E. , Slama Natalie , Sterling Stacy A. , Olfson Mark , Iturralde Esti
Published: October 2021

This study examined changes in psychotropic medication use associated with the early months of the coronavirus disease 2019 (COVID-19) pandemic. Using Kaiser Permanente Northern California electronic health records, the authors identified adult patients with fills for psychotropic medications and a non-psychotropic comparator (statins) in the 13 weeks before and after the first-known COVID-19-related death in California (March 4, 2020). Generalized estimating equations were used to derive relative risk ratios (RRR) for medication fills compared with the prior year. Analyses were stratified by new and continued fills and patient characteristics. Among 2,405,824 patients, the mean (SD) age was 49.8 (17.9) years; 52.9% were female; 47.9% identified as White; 8.0% and 7.9% had anxiety and depression disorder diagnoses, respectively. Accounting for secular trends, in the 13 weeks following March 4, 2020, there were increased fills for trazodone (RRR = 1.03, 95% CI = 1.02, 1.04), decreased fills for benzodiazepines (RRR = 0.95, 95% CI = 0.94, 0.96) and hypnotics (RRR = 0.97, 95% CI = 0.96, 0.99), and stable fills for antidepressants (RRR = 1.00, 95% CI = 0.99, 1.00). Relative rates of new fills decreased across most medication classes and continued fills either remained stable or demonstrated non-clinically significant decreases. Patients aged ≥65 years demonstrated decreased fills for most medication classes. In the first 13 weeks of the COVID-19 pandemic, fills for most psychotropic medications remained constant or showed small changes relative to the previous year. Continued (compared with new) fills accounted for observed increases in some medication classes. Older adults demonstrated decreased fills of most medications.
Effects of inhalation and propofol anaesthesia on postoperative cognitive dysfunction in elderly noncardiac surgical patients
Authors: Pang Qian-Yun , Duan Li-Ping , Jiang Yan , Liu Hong-Liang
Published: October 2021

Background:

Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the incidence of POCD and postoperative cognitive status at different time points after surgery are currently unclear.

Methods:

We searched the Embase, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs), in which inhalation anaesthesia and propofol anaesthesia were compared. The incidence of POCD or postoperative cognitive status was assessed in elderly patients undergoing noncardiac surgery.

Results:

Fifteen RCTs with 1854 patients were included in this meta-analysis. The incidence of POCD on postoperative Days 2–6 after propofol anaesthesia was markedly lower than that after inhalation anaesthesia (risk ratio (RR): 0.37, 95% confidence interval (CI): 0.15–0.88, P = .025), and Mini-Mental State Examination (MMSE) scores after propofol anaesthesia were substantially higher than those after inhalation anaesthesia (standard mean difference (SMD): 0.59, 95% CI: 0.07–1.11, P = .026). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were much lower after propofol anaesthesia than after inhalation anaesthesia (SMD: -2.027, 95% CI: -3.748– -0.307, P = .021; SMD: -0.68, 95% CI: -0.93– -0.43, P < .001).

Conclusions:

The moderate evidence from this meta-analysis shows that, in elderly noncardiac surgical patients, propofol anaesthesia is superior to inhalation anaesthesia for attenuating of early POCD incidence, and low-level evidence shows that cognitive status is higher and systemic inflammation is less severe after propofol anaesthesia in the early days after surgery.

Limitations:

The sample size was not sufficiently large for systemic inflammation, and the tools to identify POCD were not uniform in the included studies.
Epidemiology of COVID-19 in Jiangxi, China
Authors: Dong Yonghai , Ding Sheng , Zhang Jingyu , Liu Yun
Published: October 2021

To analyze the epidemiological characteristics of coronavirus disease 2019 (COVID-19) in Jiangxi Province, China, from January 21 to April 9, 2020.

COVID-19 epidemic information was obtained from the official websites of the Jiangxi Provincial Health Committee, Hubei Provincial Health Committee, and National Health Commission of the People's Republic of China. ArcGIS 10.0 was used to draw a map of the spatial distribution of the cases.

On January 21, 2020, the first COVID-19 confirmed case in Jiangxi was reported. By January 27, COVID-19 had spread rapidly to all cities in Jiangxi. The outbreak peaked on February 3, with a daily incidence of 85 cases. The last indigenous case reported on February 27. From January 21 to April 9, a total of 937 confirmed cases of COVID-19 were reported, with a cumulative incidence of 2.02/100,000. Of those, 936 patients (99.89%) were cured, and 1 (0.11%) died due to COVID-19. The COVID-19 epidemic trend in Jiangxi was basically consistent with the national epidemic trend (except Hubei). Throughout the epidemic prevention and control phase, Jiangxi province has taken targeted prevention and control measures based on the severity of the spread of COVID-19.

The COVID-19 epidemic in Jiangxi was widespread and developed rapidly. In less than 1 month, the epidemic situation was effectively controlled, and the epidemic situation shifted to a low-level distribution state. All these proved that the COVID-19 prevention and control strategies and measures adopted by Jiangxi Province were right, positive and effective.
KCa3.1 in diabetic kidney disease
Authors: Huang Chunling , Chen Xin-Ming , Pollock Carol A.
Published: October 2021

Purpose of review

Diabetic kidney disease (DKD) is a significant health concern. Innovative strategies to prevent or limit the progression of DKD are urgently needed due to the limitation of existing treatments. KCa3.1, a potassium channel, is involved in a range of biological processes from cell survival to cell death. This review summarizes the current knowledge on the pathophysiological functions of the KCa3.1 channel, specifically its involvement in maintaining mitochondrial function. More specifically, the therapeutic potential of targeting KCa3.1 in DKD is systematically discussed in the review.

Recent findings

Mitochondrial dysfunction contributes to the development and progression of DKD. Accumulating evidence indicates that KCa3.1 dysregulation plays a crucial role in mitochondrial dysfunction, in addition to driving cellular activation, proliferation and inflammation. Recent studies demonstrate that KCa3.1 deficiency improves diabetes-induced mitochondrial dysfunction in DKD, which is attributed to modulation of mitochondrial quality control through mitigating the altered mitochondrial dynamics and restoring abnormal BNIP3-mediated mitophagy.

Based on its role in fibrosis, inflammation and mitochondrial dysfunction, pharmacological inhibition of KCa3.1 may offer a promising alternative for the treatment of DKD. Due to its safety profile in humans, the repurposing of senicapoc has the potential to expedite an urgently needed new drug in DKD.
Uterus transplantation – donor and recipient work-up
Authors: Johannesson Liza , Wall Anji
Published: October 2021

Purpose of review

Uterus transplantation (UTx) is transitioning from an experimental procedure to a clinical treatment for absolute uterine factor infertility (AUFI). Standardized protocols for the evaluation and selection of donors and recipients that maximize chances of success – a healthy live birth – are needed.

Recent findings

To date, recipient eligibility has been limited to otherwise healthy women with AUFI who are of childbearing age and are good candidates for in-vitro fertilization (IVF). For donors (living or deceased), selection criteria vary, apart from basic requirements of blood-type compatibility and freedom from critical infectious diseases, but generally require a term birth and a uterus free from uterine pathologies. The stepwise evaluation process for candidate recipients and living donors moves through health screening (medical and psychosocial); initial selection committee review; IVF (recipients only); and final selection committee review. This eliminates candidates with poor chances of success before exposure to unnecessary risks.

The currently stringent selection criteria for prospective recipients and donors will likely broaden, as UTx becomes more widely available. Continued research is needed to define the donor, recipient and uterine graft factors associated with successful outcomes, and to support the development of standardized selection criteria.
Adjuvant Chemotherapy Is Not Guided by Pathologic Treatment Effect After Neoadjuvant Chemotherapy in Pancreatic Cancer
Authors: Gleeson Elizabeth M. , Leigh Natasha , Golas Benjamin J. , Magge Deepa , Sarpel Umut , Hiotis Spiros P. , Labow Daniel M. , Pintova Sofya , Cohen Noah A.
Published: October 2021

Objectives

Currently, there is no guidance for optimal adjuvant chemotherapy selection after pancreatectomy with a partial or poor response to neoadjuvant therapy. This study seeks to describe an institution's practice patterns of adjuvant chemotherapy selection after neoadjuvant therapy.

Methods

Patients at a single institution receiving neoadjuvant chemotherapy followed by pancreatectomy for pancreatic cancer were reviewed. Patients enrolled in trials or without follow-up were excluded. Types of chemotherapy, the College of American Pathologists pathologic tumor response, and medical oncology plans were recorded.

Results

Forty-one patients met inclusion criteria. Pathologic review of treatment effect demonstrated that 3 patients (7.3%) had complete pathologic response, 3 (7.3%) had near complete pathologic response, 16 (39%) had partial response, and 14 (34.1%) had poor/no response to neoadjuvant chemotherapy. Fourteen of the 30 patients with partial or poor response (46.7%) received an alternate adjuvant regimen. Pathologic response to neoadjuvant chemotherapy specifically guided therapy in 11 (30.5%) patients.

Conclusions

Despite 73.1% of patients with partial or poor response to neoadjuvant chemotherapy, only 46.7% received a different adjuvant regimen. Medical oncologists infrequently considered treatment effect when choosing adjuvant therapy. Pathologic response to neoadjuvant chemotherapy should be considered when selecting adjuvant chemotherapy.
Pancreatic Neuroendocrine Neoplasias in Multiple Endocrine Neoplasia Type 1 Are Predominantly Located in the Dorsal Anlage
Authors: Kann Peter Herbert , Scheunemann Adrian , Dorzweiler Peter , Adelmeyer Jan , Bergmann Simona , Goebel Joachim Nils , Mann Verena , Bartsch Detlef K. , Holzer Katharina , Albers Max B. , Manoharan Jerena , Scheunemann Lisann M.
Published: October 2021

Objectives

Pancreatic neuroendocrine neoplasias (pNENs) frequently occur in multiple endocrine neoplasia type 1 (MEN1). Their distribution referring to embryology, that is, the pancreatic anlagen, has not been investigated yet.

Methods

In the time between 1998 and 2019, we studied the distribution of pNENs in MEN1 concerning the embryologic origin of the pancreas, that is, the dorsal versus ventral anlage using endoscopic ultrasound in 117 MEN1 patients: 56 women, 61 men; aged 40 years (standard deviation, 14 years) at first endoscopic ultrasound.

Results

In 105 patients, a total of 628 pNENs were detected. They were located in the pancreatic tail: 231; pancreatic body: 177; pancreatic head/uncinate process: 220. Of the latter, 22 were located in the ventral anlage, 176 in the dorsal anlage, and 22 remained undefined. In summary, just 3.5% of all detected pNENs were located in the ventral anlage, 93.0% in the dorsal anlage, and 3.5% could not be assigned.

Conclusions

Our study indicates that the vast majority of pNENs in MEN1 is located in the dorsal anlage, whereas the ventral anlage of the pancreas seems to be to a large extend spared from pNENs. Implications for new surgical strategies might be considered.
Human Recombinant Arginase I [HuArgI(Co)-PEG5000]–Induced Arginine Depletion Inhibits Pancreatic Cancer Cell Migration and Invasion Through Autophagy
Authors: El-Mais Nour , Fakhoury Isabelle , Al Haddad Maria , Nohra Sarah , Abi-Habib Ralph , El-Sibai Mirvat
Published: October 2021

Objectives

Pancreatic cancer is one of the most aggressive solid cancers and the fourth leading cause of cancer death in men and women. We previously showed that arginine depletion, using arginase I [HuArgI(Co)-PEG5000], selectively triggers cell death by autophagy in PANC-1 pancreatic cancer cells. The mechanism of action of [HuArgI(Co)-PEG5000], however, has remained poorly understood. In this study, we investigated the effects of arginine depletion on PANC-1 cell migration, adhesion, and invasion and determined the main molecular targets, which mediate PANC-1 cell response to treatment with HuArgI(Co)-PEG5000.

Methods

This was done through examining 2-dimensional (2D) cell motility assays (wound healing and time lapse), cell adhesion, and cell invasion assays, as well as immunostaining for focal adhesions and invadopodia in cells without or with the treatment with arginase.

Results

We demonstrate that arginine depletion decreases PANC-1 2D cell migration, adhesion, and 3D invasion. Moreover, our data suggest that these effects are mediated by autophagy and subsequent decrease in the activation of members of Ras homolog gene family (Rho) GTPase family.

Conclusions

Altogether, these findings uncover the mechanism of action of [HuArgI(Co)-PEG5000] and highlight the promising and selective anticancer potential for arginine depletion in the treatment of pancreatic cancer cells.
Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment
Authors: Simonsen Sebastian , Popolo Raffaele , Juul Sophie , Frandsen Frederik Weischer , Sørensen Per , Dimaggio Giancarlo
Published: October 2021

Avoidant personality disorder (AvPD) is a severe but understudied condition. The current pilot project reports data on acceptability and outcomes of a novel treatment combining biweekly individual metacognitive interpersonal therapy (MIT) and weekly mentalization-based therapy (MBT) group therapy. A total of 30 patients with AvPD were consecutively included in the program. The primary outcome was AvPD-specific personality functioning measured by self-report after treatment. Secondary outcomes were symptom distress, interpersonal problems, quality of life, and psychosocial functioning. Twenty-two patients completed treatment, with a mean duration of 13 months. On the primary outcome, effect sizes were generally moderate to large (effect size range: 0.59–1.10). On secondary outcomes, effect sizes were large (effect size range: 0.77–2.3). Both in terms of acceptability and outcomes, results are promising for the combination of MIT and MBT for AvPD. The approach is a strong candidate for further investigation in future large-scale randomized controlled trial.
Are Affective Temperaments, Emotional Abuse, and Neglect Involved in Mentalization Abilities in Patients With Psychiatric Disorders?
Authors: Berardelli Isabella , Sarubbi Salvatore , Sarli Giuseppe , Rogante Elena , Del Casale Antonio , Erbuto Denise , Innamorati Marco , Lester David , Pompili Maurizio
Published: October 2021

Patients who have experienced emotional abuse and neglect often develop psychiatric disorders in adulthood. However, whether emotional abuse, neglect, and mentalization abilities relate to one another and the role of possible mediators of this relationship in psychiatric patients are still unknown. We evaluated the potential role of affective temperament as a mediator of the relationship between emotional abuse and neglect and mentalization. We performed a cross-sectional study of 252 adult psychiatric inpatients. The Childhood Trauma Questionnaire, Mentalization Questionnaire, and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered. Results showed a significant indirect effect of emotional abuse and neglect on scores on the Mentalization Questionnaire through the TEMPS-A (b = 0.25, 95% confidence interval [0.143–0.375]), demonstrating that affective temperament mediates the relationship among emotional abuse, neglect, and mentalization impairment in psychiatric patients. A careful evaluation of mentalization abilities in patients with psychiatric disorders and who have a history of emotional abuse and neglect is necessary for a better understanding of psychopathology and for the choice of therapeutic strategies.