bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of platelet-derived growth factor pathway suppresses tubulointerstitial injury in renal congestion
Authors: Matsuki Takuma , Hirose Takuo , Ohsaki Yusuke , Shimada Satoshi , Endo Akari , Ito Hiroki , Takahashi Chika , Yamakoshi Seiko , Oba-Yabana Ikuko , Anan Go , Kato Toshiko , Tajima Ryo , Nakayama Shingo , Kimura Tomoyoshi , Nakamura Hannah , Tani Junichi , Takahashi Kazuhiro , Kure Shigeo , Mori Takefumi
Published: August 2022

Objective:

Increased central venous pressure in congestive heart failure is responsible for renal dysfunction, which is mediated by renal venous congestion. Pericyte detachment from capillaries after renal congestion might trigger renal fibrogenesis via pericyte-myofibroblast transition (PMT). Platelet-derived growth factor receptors (PDGFRs), which are PMT indicators, were upregulated in our recently established renal congestion model. This study was designed to determine whether inhibition of the PDGFR pathway could suppress tubulointerstitial injury after renal congestion.

Methods:

The inferior vena cava between the renal veins was ligated in male Sprague-Dawley rats, inducing congestion only in the left kidney. Imatinib mesylate or vehicle were injected intraperitoneally daily from 1 day before the operation. Three days after the surgery, the effect of imatinib was assessed by physiological, morphological and molecular methods. The inhibition of PDGFRs against transforming growth factor-β1 (TGFB1)-induced fibrosis was also tested in human pericyte cell culture.

Results:

Increased kidney weight and renal fibrosis were observed in the congested kidneys. Upstream inferior vena cava (IVC) pressure immediately increased to around 20 mmHg after IVC ligation in both the imatinib and saline groups. Although vasa recta dilatation and pericyte detachment under renal congestion were maintained, imatinib ameliorated the increased kidney weight and suppressed renal fibrosis around the vasa recta. TGFB1-induced elevation of fibrosis markers in human pericytes was suppressed by PDGFR inhibitors at the transcriptional level.

Conclusion:

The activation of the PDGFR pathway after renal congestion was responsible for renal congestion-induced fibrosis. This mechanism could be a candidate therapeutic target for renoprotection against renal congestion-induced tubulointerstitial injury.
Impact of various night-time period definitions on nocturnal ambulatory blood pressure
Authors: Nolde Janis M. , Hillis Graham S. , Atkins Emily , Von Huben Amy , Marschner Simone , Chan Justine , Reid Christopher M. , Nelson Mark R. , Figtree Gemma , Chalmers John , Usherwood Tim , Rodgers Anthony , Chow Clara K. , Schlaich Markus P.
Published: August 2022

Background:

Several definitions of night-time BP exist for the calculation of nocturnal blood pressure (BP) based on 24-h BP measurements. How much these methods differ regarding the resulting nocturnal blood pressure values, under which circumstances these differences become clinically meaningful, and under which circumstances diary-adjusted measurements should be used preferentially remains uncertain.

Methods:

Data of 512 24-h BP recordings were analysed regarding differences in nocturnal BP based on three alternative definitions of night-time: 2300–0700 h, 0100–0500 h, and diary-adjusted measures.

Results:

Mean systolic nocturnal BP between 2300–0700 h was 2.5 mmHg higher than between 0100 and 0500 h and 1.6 mmHg higher than diary adjusted estimates. Up to 38.3% of individuals showed BP differences of more than 5 mmHg when comparing temporal definitions of night-time, resulting in significant proportions of individuals being re-classified as hypertensive. When diary-derived sleeping patterns differed by less than 2 h from the 2300 to 0700 h fixed time definition, mean BP discrepancies remained below 3 mmHg. Absolute time discrepancies between diary and 2300–0700 h fixed time definition of 2–4, 4–8 or at least 8 h led to SBP/DBP differences of 4.1/3.1, 6.8/6.1, and 14.5/9.1mmHg, respectively.

Conclusion:

Average differences of nocturnal BP between varying definitions in study/cohort data are small and would be of limited relevance in many settings. However, substantial differences can be observed in individual cases, which may affect clinical decision-making in specific patients. In patients whose sleeping patterns differs by more than 2 h from defined fixed night-times, diaries should be used for adjustment.
Young South Asian women in the United Kingdom show evidence of blunted endothelium-dependent dilatation: implications for future cardiovascular disease
Authors: Ali Majid , Hussein Zainab , Marshall Janice M.
Published: August 2022

Introduction:

Prevalence of cardiovascular disease (CVD) is higher in South Asians than white Europeans. The offspring of hypertensive parents (OH) have greater risk of hypertension than offspring of normotensive parents (ON). We hypothesized that endothelium-dependent dilatation is already blunted in young South Asians, relative to young white European women, particularly in South Asian OH women.

Methods:

In young white European ON, South Asian ON and OH women (18–25 years old; 10 per group) who were normotensive, we recorded cutaneous perfusion by laser Doppler fluximetry during reactive hyperaemia and iontophoresis of acetylcholine (ACh), before and after inhibiting NO synthesis (NOS) or/and cyclooxygenase (COX). In these and an additional 135 age-matched South Asian and white European women, physical activity and life-style factors were assessed by questionnaire.

Results:

ACh-evoked dilatation was blunted in young South Asians, relative to white European women. It was attenuated by NOS or COX inhibition in white European ON; by NOS inhibition only in South Asian ON, but not OH women. After combined NOS and COX inhibition, ACh-evoked dilatations were similar to control ACh responses. Similar findings were made for reactive hyperaemia. Questionnaire data indicated young South Asians have lower physical activity levels, fresh fruit and vegetable intake than white European women, South Asian OH being lower than white European ON, or OH women.

Conclusion:

Endothelium-dependent dilatation is blunted in young South Asians, relative to white European women, especially in South Asian OH in whom NO-dependent and prostaglandin-dependent dilatation is blunted. We suggest improved diet and greater physical activity could be particularly effective in improving endothelium-dependent dilatation and reducing future CVD risk in young South Asian OH women.
Ultrasound-Guided Pars Plana Vitrectomy
Authors: Berrones David , Rivera-Cortes Mariana , Monroy-Esquivel Luz , Becerra-Revollo Catalina , Mayorquin-Ruiz Mariana , Velez-Montoya Raul
Published: August 2022

Purpose:

To assess the feasibility of a novel surgical technique that combines B-scan ultrasound with modern vitrectomy techniques.

Methods:

Patients with a clinical diagnosis of infectious keratitis endophthalmitis, which were scheduled for pars plana vitrectomy and ruled out as candidates for transient keratoprosthesis, were enrolled. The ultrasound probe was placed over the eye to use the images to witness the vitreous movement around the cutter and to establish its position in relation to the retinal wall. The procedure was performed in at least four ultrasound projections (longitudinal-9,6, 3, and 12). All patients were followed for three months, and in each visit, the visual acuity and the presence of adverse effects were assessed.

Results:

Overall, 12 patients (mean age: 56.2 ± 18.4 years) were enrolled. Visual acuity at baseline was 2.3 ± 0.25 logarithm of the minimum angle of resolution. Sixty-six percent achieved inactivation of endophthalmitis. Two patients had evisceration caused by uncontrolled infection, and two more had retinal detachment during follow-up. Visual acuity at the end of follow-up was 2.1 ± 0.3 logarithm of the minimum angle of resolution (P = 0.5).

Conclusion:

Ultrasound-guided vitrectomy is a feasible surgical technique. More studies are needed to assess its safety profile and optimize outcomes.
Increased Risk of Ocular Hypertension in Patients With Cushing’s Disease
Authors: Ma Yichen , Chen Zhengyuan , Ma Zengyi , Ye Hongying , Zhang Zhaoyun , Wang Yongfei , Yang Huiyin , Lu Zhaozeng , Wang Zhiliang , Qiao Nidan , Xiao Yiqin , Zhao Yao
Published: August 2022

Précis:

An increased risk of ocular hypertension was seen in Cushing's disease.

Introduction:

Systemic steroid use is a significant risk factor for increased intraocular pressure (IOP). The incidence of ocular hypertension may rise to 30%–40% of the general population due to topical or systemic glucocorticoid usage. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to surgical resection, remain unknown.

Materials and Methods:

The IOP, visual field, and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing’s disease (CD) admitted to a tertiary pituitary center for surgery from January to July 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period served as controls. We calculated the odds ratio (OR), identified the risk factors of developing ocular hypertension, and presented postoperative trends of the IOP.

Results:

A total of 52 patients (38.4±12.4 y old) with CD were included. The IOP was higher in patients with CD (left 19.4±5.4 mm Hg and right 20.0±7.1 mm Hg) than in patients with acromegaly (left 17.5±2.3 mm Hg and right 18.6±7.0 mm Hg, P=0.033) and patients with NFPA (left 17.8±2.6 mm Hg and right 17.4±2.4 mm Hg, P=0.005). A total of 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension compared with 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The OR of developing ocular hypertension in patients with CD was 5.1 [95% confidence interval (CI), 1.3–25.1, P=0.029] and 6.6 (95% CI, 1.8–30.3, P=0.007) when compared with the 2 control groups. Among patients with CD, those with a higher urine-free cortisol were more likely to develop ocular hypertension (OR=19.4, 95% CI, 1.7–72.6). The IOP decreased at 1 month after surgery in patients with CD, and the change was sustained for 3 months after surgery.

Conclusions:

An increased risk of ocular hypertension was seen in CD and suggests that endogenous hypercortisolemia should be considered as part of the glaucoma assessment. This result warrants the discretion of both ophthalmologists and neuroendocrinologists.
Maraviroc Population Pharmacokinetics Within the First 6 Weeks of Life
Authors: Liyanage Marlon , Nikanjam Mina , McFadyen Lynn , Vourvahis Manoli , Rogg Luise , Moye John , Chadwick Ellen G. , Jean-Philippe Patrick , Mirochnick Mark , Whitson Kyle , Bradford Sarah , Capparelli Edmund V. , Best Brookie M.
Published: August 2022

Background:

Treatment and prophylaxis options for neonatal HIV are limited. This study aimed to develop a population pharmacokinetic model to characterize the disposition of maraviroc in neonates to inform dosing regimens and expand available options.

Methods:

Using maraviroc concentrations from neonates who received either a single dose or multiple doses of 8 mg/kg of maraviroc in the first 6 weeks of life, a population pharmacokinetic model was developed to determine the effects of age, sex, maternal efavirenz exposure and concomitant ARV therapy on maraviroc disposition. The final model was used in Monte Carlo simulations to generate expected exposures with recommended dosing regimens.

Results:

A total of 396 maraviroc concentrations, collected in the first 4 days of life, at 1 week, at 4 weeks and at 6 weeks, from 44 neonates were included in the analysis. After allometrically scaling for weight, age less than 4 days was associated with a 44% decreased apparent clearance compared with participants 7 days to 6 weeks of life. There were no differences identified in apparent clearance or volume of distribution from ages 7 days to 6 weeks, sex, maternal efavirenz exposure or concomitant nevirapine therapy. Monte Carlo simulations with FDA-approved weight band dosing resulted in the majority of simulated patients (84.3%) achieving an average concentration of ≥75 ng/mL.

Conclusions:

While maraviroc apparent clearance is decreased in the first few days of life, the current FDA-approved maraviroc weight band dosing provides maraviroc exposures for neonates in the first 6 weeks of life, which were consistent with adult maraviroc exposure range. Maraviroc provides another antiretroviral treatment option for very young infants.
Detectability of Hepatitis B Virus in Peripheral Blood Mononuclear Cells Among Naive Chronic Hepatitis B Patients With Negative Viremia
Authors: Osman Heba A. , Hetta Helal F. , El-Adly Ahmad M. , Meshaal Ahmad K. , Mekky Mohamed A.
Published: August 2022

Background and Study Aim

Studies analyzed the extrahepatic reservoir of hepatitis B virus (HBV), especially in those with chronic HBV who are hepatitis B surface antigen positive but have a negative peripheral viremia, are still scarce. Therefore, we aimed to investigate the presence of HBV-DNA in peripheral blood mononuclear cells (PBMCs) and to evaluate different factors affecting this.

Patients and Methods

A total of 1650 naive chronic hepatitis B patients were recruited. Among these patients, 320 (19.4%) (75% were male [n = 240]; mean ± SD age, 38.4 ± 12.8 years) have a persistently negative serum real-time polymerase chain reaction (PCR) for HBV-DNA without previous treatment experience. For all patients, hepatic function tests and fibrosis assay by Fibroscan and hepatitis C virus coinfection, as well as HBV-DNA-PCR in both serum and PBMCs were analyzed.

Results

More than half of them (n = 170, 53.1%) exhibited positive HBV-DNA in PBMCs. The mean logarithm 10 of quantitative HBV-DNA by PCR in PBMCs was (5.1 ± 0.3 IU/mL). Hepatitis C virus coinfection was found in 30 patients (17.6%). Most of them (320 patients) had insignificant fibrosis scores (less than F2). The multivariate logistic regression analysis for prediction of presence of detectable HBV-positive viremia in PBMCs yielded the following risk factors (odds ratio [OR]): the presence of hepatitis C virus coinfection (OR = 1.7) and a logarithm 10 of quantitative hepatitis B surface antigen more than 3 (OR = 1.1).

Conclusions

A considerable number of patients with negative plasma HBV-DNA are still harboring subtle form of virus within remote extrahepatic compartments. Thus, dual testing for both plasma and PBMCs is mandatory especially in epidemiologic studies.
3D Cube FLAIR plus HyperSense compressed sensing is superior to 2D T2WI FLAIR scanning regarding image quality, spatial resolution, detection rate for cortical microinfarcts
Authors: Liu Tiefang , Wang Yonghao , Xu Zhengyang , Wu Tao , Zang Xiao , Li Meng , Li Jinfeng
Published: August 2022

3-dimention (3D) Cube isotropic volumetric magnetic resonance imaging (MRI) facilitates comprehensive recognition of microinfarcts while it takes long scanning time. HyperSense compressed sensing is an emerging technique for accelerating MRI acquisition to reduce scanning time, while its application along with 3D Cube MRI for microinfarcts is seldom reported. Therefore, this study aimed to investigate the efficiency of 3D Cube FLAIR plus HyperSense compressed sensing technique versus conventional 2-dimention (2D) FLAIR scanning in the detection of cortical microinfarcts (CMIs).

Totally 59 patients with cerebrovascular disease were enrolled then scanned by 3D Cube FLAIR plus HyperSense compressed sensing and 2D T2WI FLAIR sequences. The image quality scores, signal-to-noise ratio (SNR) for gray matter (GM), SNR for white matter (WM), their contrast-to-noise ratio (WM-to-GM CNR), detected number of CMIs were evaluated.

3D Cube FLAIR plus HyperSense showed a dramatically increased scores of uniformity, artifact, degree of lesion displacement, and overall image quality compared to 2D T2WI FLAIR. Meanwhile, it exhibited similar SNRwm and SNRgm, but a higher WM-to-GM contrast-to-noise ratio compared with 2D T2WI FLAIR. Furthermore, the scanning time of 3D Cube FLAIR plus HyperSense and 2D T2WI FLAIR were both set as 2.5 minutes. Encouragingly, 244 CMIs were detected by 3D Cube FLAIR plus HyperSense, which was higher compared to 2D T2WI FLAIR (106 detected CMIs).

3D Cube FLAIR plus HyperSense compressed sensing is superior to 2D T2WI FLAIR scanning regarding image quality, spatial resolution, detection rate for CMIs; meanwhile, it does not increase the scanning time. These findings may contribute to early detection and treatment of stroke.
Tissue attenuation imaging and tissue scatter imaging for quantitative ultrasound evaluation of hepatic steatosis
Authors: Rónaszéki Aladár D. , Budai Bettina K. , Csongrády Barbara , Stollmayer Róbert , Hagymási Krisztina , Werling Klára , Fodor Tamás , Folhoffer Anikó , Kalina Ildikó , Győri Gabriella , Maurovich-Horvat Pál , Kaposi Pál N.
Published: August 2022

We aimed to assess the feasibility of ultrasound-based tissue attenuation imaging (TAI) and tissue scatter distribution imaging (TSI) for quantification of liver steatosis in patients with nonalcoholic fatty liver disease (NAFLD). We prospectively enrolled 101 participants with suspected NAFLD. The TAI and TSI measurements of the liver were performed with a Samsung RS85 Prestige ultrasound system. Based on the magnetic resonance imaging proton density fat fraction (MRI-PDFF), patients were divided into ≤5%, 5–10%, and ≥10% of MRI-PDFF groups. We determined the correlation between TAI, TSI, and MRI-PDFF and used multiple linear regression analysis to identify any association with clinical variables. The diagnostic performance of TAI, TSI was determined based on the area under the receiver operating characteristic curve (AUC). The intraclass correlation coefficient (ICC) was calculated to assess interobserver reliability.

Both TAI (rs = 0.78, P < .001) and TSI (rs = 0.68, P < .001) showed significant correlation with MRI-PDFF. TAI overperformed TSI in the detection of both ≥5% MRI-PDFF (AUC = 0.89 vs 0.87) and ≥10% (AUC = 0.93 vs 0.86). MRI-PDFF proved to be an independent predictor of TAI (β = 1.03; P < .001), while both MRI-PDFF (β = 50.9; P < .001) and liver stiffness (β = −0.86; P < .001) were independent predictors of TSI. Interobserver analysis showed excellent reproducibility of TAI (ICC = 0.95) and moderate reproducibility of TSI (ICC = 0.73).

TAI and TSI could be used successfully to diagnose and estimate the severity of hepatic steatosis in routine clinical practice.
The association between sleep and suicidality in the presence and absence of depressive symptoms: A cross-sectional study in rural China
Authors: Liu Xiao-Kun , Li Qi-Fu , Han Dong-Chou , Cheng Wei , Song Na , Hu Mi , Xiao Shui-Yuan
Published: August 2022

This study aimed to explore the association between sleep and suicidality in the presence and absence of depressive symptoms in the rural Chinese population. The research involved a cross-sectional survey conducted in Liuyang, China, between November 2010 and August 2011. A total of 2052 participants were surveyed (987 males and 1065 females). To investigate the mediating effect of depressive symptoms in the correlation between sleep quality and suicidality. The association between sleep quality and suicidality in the absence of depressive symptoms was also explored. Suicide risk was measured using the Mini-International Neuropsychiatric Interview subscale. The visual analog scale was used to assess sleep quality. Patient Health Questionnaire-9 and Patient Health Questionnaire-2, avoiding the overlap in sleep and suicidality assessments, were used for detecting depressive symptoms in participants. Depressive symptoms partially mediated the association between sleep quality and suicidality among rural adults. Furthermore, some participants did not exhibit depressive symptoms in this study yet still exhibited a risk for suicidality, with poor sleep quality contributing significantly to their suicidality even after adjusting for cofounders. Poor sleep quality significantly increases the likelihood of suicidality in the presence and absence of depressive symptoms in the rural Chinese population. Poor sleep quality could correlate with increased suicide risk independently of depressive symptoms.
Perceptions and attitudes toward participation in clinical research in the Eastern Mediterranean Region: A systematic review
Authors: Aabdien Mohamed , Abdallah Ibtihal , Bougmiza Mohamed Iheb , Siepmann Timo , Illigens Ben
Published: August 2022

Introduction:

Successful recruitment of participants into clinical research has always been challenging and is affected by many factors. This systematic review aimed to explore the perceptions and attitudes as well as identify the factors affecting the participation in clinical research among the Eastern Mediterranean Regional Office countries’ population.

Methods:

A systematic search of the literature was conducted to explore attitudes or perceptions of the general public or patients towards participation in clinical research. PubMed, Pro-Quest Central, World Health Organizations Index Medicus for the Eastern Mediterranean Region, and Google Scholar were searched. Studies were considered eligible for inclusion if they presented primary data and were conducted in one of the Eastern Mediterranean Regional Office countries. A data extraction sheet was used to record the following: year, country, aim, population, sample size, study design, data collection, and setting. The identified factors from the included studies were categorized into motivators and barriers.

Results:

In total, 23 original research articles were identified that addressed perceptions or attitudes towards clinical research participation. Six main motivators and barriers of research participation among patients, the general public, and patient family members were identified. The most common cited motivators included personal benefits to the individual, altruism and the desire to help others, the research process, the influence of the physician, family encouragement, and religion. Concerns regarding safety, confidentiality, and other factors in addition to the research process, lack of trust in healthcare providers or healthcare system, lack of interest in research and no perceived personal benefit, religious concerns, and family/cultural concerns were the most cited barriers to participation.

Conclusion:

The identified motivators and barriers are essential to tackle during clinical research planning among the population of Eastern Mediterranean Regional Office countries. Further research is needed to assess the attitudes and perceptions of individuals approached to participate in trials.
Efficacy of interventional radiology in the management of portal hypertension: A narrative review
Authors: Ishikawa Toru
Published: August 2022

Portal hypertension is associated with numerous adverse effects, including the formation of gastroesophageal varices and a portal vein general circulation shunt. Portal hypertension can lead to portal blood flow into the liver and a subsequent reduction in liver function. Clinical interventions can be hampered by a concurrent reduction in circulating platelets associated with increased splenic activity. Pharmaceutical interventions for the treatment of complications associated with portal hypertension have achieved various degrees of success. However, an effective therapeutic strategy for portal hypertension has not yet been established. A literature search was performed using “PubMed.” Database between 1966 and January 2021 using the following keywords: portal hypertension, interventional radiology, balloon-occluded retrograde transvenous obliteration, transjugular retrograde obliteration of gastric varices, percutaneous transhepatic obliteration, partial splenic embolization, and transjugular intrahepatic portosystemic shunting. In this narrative review, we summarize the application of interventional radiology in patients with portal hypertension, including techniques for embolization of collateral veins and portal pressure reduction. These up-to-date interventional radiology techniques can be used to treat portal hypertension. The data that support the findings of this study are available from the corresponding author, upon reasonable request.
Expression level and prognostic potential of beta-catenin–interacting protein in acute myeloid leukemia
Authors: Han Hui , Zhu Baofang , Xie Jinye , Huang Yunxiu , Geng Yiyun , Chen Kang , Wang Weijia
Published: August 2022

Inhibitor of beta-catenin and TCF (ICAT) is a key protein in the Wnt-β-catenin signaling pathway. However, its role in acute myeloid leukemia (AML) remains unknown. In this study, we evaluated its expression level as well as its prognostic value in AML patients. A total of 72 patients with AML and 30 control subjects were enrolled in this study during the period of January 2017 and December 2019 at Zhongshan Hospital of SunYat-sen University. ICAT and β-catenin expression levels in peripheral blood were determined via enzyme-linked immunosorbent assays. ICAT levels in AML patients were significantly lower and β-catenin levels were higher than those of the control group. After the first course of standard chemotherapy, the concentration of ICAT in the partial remission group (93.79 ng/mL) was significantly higher than that in the initial diagnosis group (49.38 ng/mL) and the no response group (39.94 ng/mL). AML subtypes had lower ICAT expression levels than controls, and ICAT levels were significantly correlated with body mass index, bone marrow/peripheral blood blast cell proportions, and white blood cell and red blood cell counts at initial diagnosis. Furthermore, low ICAT expression was found to be associated with poor disease-free survival and overall survival in AML. ICAT is closely associated with AML progression and can be used as an indicator to monitor AML treatment efficacy.
Clinical efficacy of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery
Authors: Miao Xin , Liu Li , Wang Xiang , Fan Zhining , Miao Lin , Wang Jiankun
Published: August 2022

Benign anastomotic stricture is a frequent complication after rectal surgery. This study investigated the feasibility of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery. 31 patients who diagnosed with benign anastomotic stricture after rectal surgery were included in this study. 15 patients received simple endoscopic dilation (dilation group) and 16 patients received endoscopic dilation combined with bleomycin injection (bleomycin group). The clinical effect and adverse events were compared in the 2 groups. The strictures were managed successfully and the obstruction symptoms were relieved immediately. There were 2 minor complications in dilation group and 3 minor complications in bleomycin group. The difference was not significant between the 2 groups (P > .05). During the follow-up, the mean reintervention interval was 4.97 ± 1.00 months in dilation group and 7.60 ± 1.36 months in bleomycin group. The median treatment times was 4 (range 3–5) in dilation group and 2 (range 2–3) in bleomycin group. The differences in the 2 groups were significant (P < .05). Compared with endoscopic dilation, endoscopic dilation combined with bleomycin injection may reduce the treatment times and prolong the reintervention interval, which is a safe and effective endoscopic management for benign anastomotic stricture after rectal surgery.
Neurosyphilis presenting as autoimmune limbic encephalitis: A case report and literature review
Authors: Mizoguchi Tomotaka , Hara Makoto , Nakajima Hideto
Published: August 2022

Rationale:

Neurosyphilis presenting as limbic encephalitis (LE) is an important differential diagnosis of autoimmune LE (ALE) defined by Graus in 2016. However, data on the clinical differences and similarities between neurosyphilis presenting as LE and ALE are limited. Herein, we report neurosyphilis presenting as ALE that fulfilled the main items of the Graus ALE criteria. Moreover, a literature review of neurosyphilis presenting as LE was performed.

Patient concerns:

A 66-year-old Japanese man developed nonconvulsive status epilepticus. He presented with progressive personality change and working memory deficits within 3 months prior to admission. A hyperintense lesion localized in the bilateral medial temporal area was observed on T2-weighted fluid-attenuated inversion recovery brain magnetic resonance imaging. Cerebrospinal fluid analysis showed mild pleocytosis and the presence of oligoclonal band. However, in-house assays did not detect antineuronal antibodies. Electroencephalogram showed lateralized rhythmic delta activity in the right temporal area. The serum and cerebrospinal fluid serological and antigen tests for syphilis had positive results.

Diagnosis:

ALE was initially suspected based on the patient’s symptoms and ancillary test findings that fulfilled the Graus ALE criteria. However, based on the positive confirmatory test results for syphilis, a diagnosis of neurosyphilis was eventually made.

Intervention:

The patient received intravenous midazolam, oral levetiracetam, and lacosamide to control nonconvulsive status epilepticus. In addition, he was treated with intravenous benzylpenicillin at a dose of 24 million units/day for 14 days.

Outcomes:

The patient’s cognitive function relatively improved after antibiotic treatment. However, he presented with persistent mild working memory deficit, which was evaluated with the Wechsler Adult Intelligence Scale, 3rd edition. Therefore, on day 103 of hospitalization, he was transferred to another hospital for rehabilitation and long-term care due to limitations in performing activities of daily living.

Lessons:

The present case was diagnosed with neurosyphilis presenting as ALE, but meanwhile, in most case, neurosyphilis presenting as LE developed at a slower progressive rate, and it had a broader or restricted involvement on brain MRI than ALE based on the literature review. Therefore, an appropriate differential diagnosis of LE can be obtained by identifying clinical differences between the 2 conditions.
New-onset crescent IgA nephropathy following the CoronaVac vaccine: A case report
Authors: Ran Enrong , Wang Maohe , Wang Yanmei , Liu Rongzhi , Yi Yanxia , Liu Yuanjun
Published: August 2022

Rationale:

Although coronavirus disease 2019 (COVID-19) remains a global threat, administering effective and safe vaccines is currently the most promising strategy to curb the ongoing pandemic and decrease the number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, there remains some uncertainty regarding the safety of vaccines for patients with kidney disease.

Patient concerns:

A 58-year-old man presented at our institution with gross hematuria 48 hours after receiving his first dose of the CoronaVac (Sinovac) vaccine.

Diagnoses:

Analysis of a renal biopsy sample led to the diagnosis of crescentic immunoglobulin A nephropathy (IgAN), which we considered an adverse event of receiving the CoronaVac vaccine in China.

Interventions:

The patient’s serum creatinine and albumin levels were 1.20 mg/dL and 31.3 g/L, respectively; as such, he was administered a diuretic. His serum creatinine level had risen to 7.45 mg/dL 1 month later, and he developed high blood pressure. The patient then received conventional doses of hormone therapy but developed recurrent fever, which led to the suspicion of active tuberculosis (which he had a history of) and suspension of the hormone therapy.

Outcomes:

The patient’s renal function deteriorated further, and he ultimately underwent dialysis.

Lessons:

The patient’s course of events of apparent IgAN exacerbation should prompt nephrologists to closely follow patients with glomerular disease after they receive a COVID-19 vaccine, especially if persistent gross hematuria occurs.
A case report of pediatric systemic lupus erythematosus with diffuse alveolar hemorrhage following COVID-19 infection: Causation, association, or chance?
Authors: Asseri Ali Alsuheel , Al-Murayeh Raneem , Abudiah Abdoh M. , Elgebally Elsayed I. , Aljaser Abdullah M.
Published: August 2022

Rationale:

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of childhood systemic lupus erythematosus (SLE) that can be life-threatening. Several reports have linked previous or concurrent coronavirus disease (COVID-19) infections with a high prevalence of autoimmune and autoinflammatory disorders.

Patient concerns:

We report a case of a 13-year-old female who presented with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection.

Diagnoses:

The patient was diagnosed with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection.

Interventions and outcomes:

The patient was treated with intravenous methylprednisolone pulse, broad-spectrum antibiotics, and supportive measures. In addition, she received 6 sessions of plasma exchange and maintenance methylprednisolone therapy (2 mg/kg/day). The patient then improved and was discharged on prednisolone, hydroxychloroquine, and azathioprine.

Lessons:

We suggest plasmapheresis be considered a treatment for SLE-associated DAH in the context of active disease when conventional treatment has failed to induce a rapid response. In addition, further studies are needed to assess the role of COVID-19 as an autoimmune disease trigger, particularly for SLE.
Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis
Authors: Lee Sung ho , Cho Young Jae , Choi Won Kee
Published: August 2022

To compare femoral sagittal axis between navigated total knee arthroplasty (TKA) and conventional TKA.

A total of 136 cases were assigned to group 1 (navigated TKA) and 77 cases were assigned to group 2 (conventional TKA). Specifically, this study targeted patients with degenerative osteoarthritis. Only patients with primary TKA were analyzed. Hip knee ankle angle and lateral femoral bowing were measured using preoperative scanogram. Anterior femoral bowing was measured using preoperative femoral lateral X rays. The presence of anterior femoral notching and the insertion angle of the femoral implant with respect to the anatomical sagittal plane of the distal femur were checked using postoperative lateral knee X rays. Student t-test was used to compare the difference in the position of the sagittal plane of the femoral implant between the navigated TKA group and the conventional TKA group.

When comparing the 2 groups, the sagittal axis of the femoral implant was more extended than the anatomical sagittal plane axis of the distal femur in group 1 than in group 2 (P = .01). There was a significant negative correlation between the value of anterior femoral bowing and the degree of flexion to the sagittal plane of the femoral implant in group 1 (correlation coefficient: –0.40, P = .01). The occurrence of anterior femoral notching was significantly higher in group 1 than in group 2.

During navigated TKA, imageless navigation does not consider the anatomical variation of the femoral shaft. Therefore, surgeons should take into consideration that when performing navigated TKA, a femoral implant could be inserted more extended for the anatomical sagittal axis of the distal femur than for the conventional TKA. Also, surgeon should know that the degree of extension insertion of the femoral implant increases as femoral anterior bowing increases.
Differences in orexin-A level in the functional brain network of HUD patients undergoing harm reduction therapy
Authors: You Wan-Ru , Lin Liang-Chun , Lin Wei-Che , Tsai Meng-Chang
Published: August 2022

Orexins regulate the reward-seeking pathway and also play a role in drug addiction. The aim of this study was an investigation of the changes in serum level of orexin-A as well as changes in the functional brain network in heroin use disorder (HUD) patients undergoing harm reduction therapy (HRT).

Twenty-five HUD patients undergoing HRT that included methadone and buprenorphine, and 31 healthy control (HC) subjects, were enrolled for this study. Serum orexin-A levels and brain-derived neurotrophic factor were measured with assay kits. The functional brain network in HUD patients and HC was investigated and assessed using seed-based analysis and functional brain MRI scans.

t Tested orexin-A levels were found to be significantly higher in HUD patients undergoing HRT than in HCs (P < .05). Analysis showed the functional activity of the right ventral anterior insula (RVAI) in HUD patients to be significantly lower than in HCs (P < .05, Family-Wise Error) corrected). In addition, the internetwork functional connectivity was significantly lower in the left nucleus accumbens and left dorsal anterior insula in the HUD subjects than in HCs (P < .05, Family-Wise Error corrected).

In this study, no significant correlation between orexin-A levels and functional brain networks was found. However, the results suggest that HRT might increase orexin-A levels and decrease functional activity in RVAI in HUD patients.
Recurrent respiratory infections and vitamin A levels: a link? It is cross-sectional
Authors: Abdelkader Ashraf , Wahba Ashraf A. , El-tonsy Mohamed , Zewail Amr Abdelfattah , Shams Eldin Mohamed
Published: August 2022

Respiratory tract infections are common illnesses in children, causing significant morbidity and negatively affecting their health. Vitamin A protects against infections and maintains epithelial integrity. The goal of this study was to determine the correlation between vitamin A deficiency and recurrent respiratory tract infections (RRTIs). Participants in this cross-sectional study were divided into 3 groups: RRTIs (including patients with history of RRTIs presenting with respiratory tract infection symptoms), RTI (including patients without history of RRTIs presenting with respiratory tract infection symptoms), and control (including children who came for a routine health checkup without a history of RRTIs or respiratory tract infection symptoms). The vitamin A assay was performed using high-performance liquid chromatography. The study included 550 children aged 6.64 ± 2.61 years. The RRTIs group included 150 children (27.3%), the RTI group included 300 children (54.5%), and the control group included 100 children (18.2%). Subclinical vitamin A deficiency and vitamin A deficiency affected 3.1% and 1.3% of subjects, respectively. Subclinical vitamin A deficiency and vitamin A deficiency were higher in children with RRTIs than in those with RTI (8% vs 1.3%, P = .001 and 4% vs 0.3%, P = .006). Additionally, children with RRTIs had significantly higher rates of subclinical vitamin A deficiency and vitamin A deficiency than those in the control group, which had 1% subclinical vitamin A deficiency (P = .017) and no cases of vitamin A deficiency (P = .043). The RRTIs group had higher rates of otitis media (27.3%), sinusitis (20%), and pneumonia (4.7%) than the RTI group (P = .002). Vitamin A insufficiency was associated with RRTIs in children.
Is percutaneous kyphoplasty safe and beneficial for patients aged 90 and over?
Authors: Yang Bo , Zhao Yu , Zhao Yangxue
Published: August 2022

Background:

At present, to a large extent, we do not know the safety and benefits of minimally invasive surgery for elderly patients, especially the focus population of patients aged 90 and over.

Methods:

We analyzed 189 consecutive patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty (PKP) between January 2018 and June 2021 at our institution. We divided them into the advanced age group aged 90 years or over (group A, n = 14) and the younger group under 90 years (group Y, n = 175). Clinical and complication indicators were evaluated and compared between the 2 groups.

Results:

A significant difference was observed in the procedure time, bleeding volume, and bone mineral density between the 2 groups during an average follow-up of 22 months. However, no significant difference was revealed in clinical and complication indicators between the 2 groups, and the pain and activity function of the 2 groups were significantly improved compared with those before PKP.

Conclusions:

Apparently, our results show that PKP is safe and beneficial for patients aged 90 years or older.
Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report
Authors: Xu Ying-Jie , Gao Xu , Ding Hao , Bu Xian-Min , Wang Hai-Bin , Wu Bin
Published: August 2022

Rationale:

To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.

Patient concerns and diagnosis:

Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3–10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.

Interventions:

All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.

Outcomes:

Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73–90) days. The bone transport time was 97 (88.3–105.3) days, and the bone mineralization time was 164.5 (156.8–181.3) days, and the healing time of the docking sites was 6.8 (6.1–8.3) months. The external fixator time was 14.5 (12.5–17) months with the external fixation index was 1.5 (1.4–1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.

Lessons:

One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.
Remdesivir Administration in COVID-19 Patients With Renal Impairment: A Systematic Review
Authors: Davoudi-Monfared Effat , Ahmadi Arezoo , Karimpour-Razkenari Elahe , Shahrami Bita , Najmeddin Farhad , Mojtahedzadeh Mojtaba
Published: August 2022

Background:

Remdesivir (RDV) is the main antiviral for the treatment of moderate to severe forms of Coronavirus disease 2019 (COVID-19). Several studies revealed a shortening time to clinical improvement of COVID-19 and mortality benefits in patients receiving RDV. The patients with renal disease were excluded from large clinical trials of RDV, and the probable nephrotoxicity of the drug, its metabolites, and the vehicle (sulfobutylether-β-cyclodextrin) have led to the recommendation against using RDV in patients with an estimated glomerular filtration rate of <30 mL/min.

Areas of Uncertainty:

This systematic review aimed to collect data about the necessity and safety administration of RDV in the setting of renal impairment.

Data Sources:

Search through databases including MEDLINE, ScienceDirect, Cochrane Library, and PubMed was performed. The studies were carried out in adults and enrolled patients with different types of renal impairment (ie, acute kidney injury, chronic kidney disease, kidney transplant, and renal replacement therapy) were included. Eligible studies were assessed, and required data were extracted.

Results:

Twenty-two cross-sectional studies, cohorts, case reports, and case series were included in this review. The mortality rate was between 7.3% and 50%, and various severity of COVID-19 was included in the studies. None of them reported an increase in adverse effects attributed to RDV administration. A decrease in inflammatory mediators and other benefits were obvious.

Conclusions:

Although the manufacturer's labeling does not recommend RDV administration in patients with severe renal impairment, it seems that nephrotoxicity is less concerning in the population of these patients. Moreover, RDV may be helpful in acute kidney injury induced by the viral invasion of COVID-19. To the best of our knowledge, this is the first systematic review of the use of RDV in kidney failure. Larger, well-designed, and pharmacokinetic studies are required to have a safe and logical recommendation about the use of RDV in patients with renal disorders.
Staying Strong and Healthy During Androgen Deprivation Therapy
Authors: Myers Jamie S. , Manson Alana , Billinger Sandra A. , Hamilton-Reeves Jill , Parker William , Maliski Sally L.
Published: August 2022

Background

Androgen deprivation therapy (ADT) for prostate cancer is associated with cardiovascular comorbidities and numerous adverse effects decreasing health-related quality of life. Both exercise and dietary interventions have shown promise in reducing ADT-related negative sequelae. However, feasibility for personalized combined exercise/nutrition/education interventions is not well established.

Objective

The purpose of this randomized, controlled, mixed-methods pilot study was to evaluate the feasibility of a nurse-led, telephone-delivered education, exercise, and nutrition intervention, Staying Strong & Healthy, to minimize ADT-related cardiovascular/metabolic risks and symptoms.

Methods

Staying Strong & Healthy involves individually tailored education, exercise (aerobic and resistance), and nutrition intervention delivered over 6 months and was compared with attention control. The primary quantitative outcome measure was change from baseline in low-density lipoprotein. Secondary outcomes included change in lipid levels (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides), fasting blood glucose, hemoglobin A1c, health-related quality of life, and diet quality. Assessments were performed at baseline, 6 months, and 12 months.

Results

Feasibility was demonstrated by low attrition rates and high participant satisfaction. No between-group differences were demonstrated in the cardiovascular/metabolic outcomes. Significant within-group improvements were noted for high-density lipoprotein and hemoglobin A1c in the intervention group.

Conclusion

The study results indicate that participation in a personalized, nurse-delivered exercise, nutrition, and educational intervention is feasible and acceptable to men with prostate cancer receiving ADT.

Implications for Practice

Future randomized controlled research powered to detect significant differences is needed to confirm the impact of the Staying Strong & Healthy intervention on reduction of the cardiovascular/metabolic impact of ADT for men with prostate cancer.