bluuebunny/crossref_metadata_2025 huggingface dataset:
miR-532-3p inhibits the progression of tongue squamous cell carcinoma by targeting podoplanin
Authors: Liu Zhi-Yun , Zhao Chun-Guang
Published: December 2021

Background:

The association between miR-532-3p and tongue squamous cell carcinoma (TSCC) has been examined in the literature to improve the survival rate of patients with this tumor. However, further studies are needed to confirm the regulatory roles of this microRNA (miRNA) in TSCC. The objective of this study was to investigate the roles played by and the underlying mechanism used by the miR-532-3p/podoplanin (PDPN) axis in TSCC development.

Methods:

Western blotting and quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR) were performed to evaluate the PDPN expression level in TSCC tissues and cells. The proliferative, adhesive, and migratory capabilities of TSCC cells (CAL-27 and CTSC-3) were examined using cell counting kit-8 (CCK-8), cell adhesion, and wound-healing assays, respectively. The dual-luciferase reporter (DLR) assay was later conducted to confirm the relationship between miR-532-3p and PDPN.

Results:

The results indicated that PDPN expression was enriched in TSCC tissues and cells, and that the expression of PDPN was associated with some clinicopathological parameters of TSCC, including lymph node metastasis (P = 0.001), tumor-node-metastasis (TNM) staging (P = 0.010), and grading (P = 0.010). Further analysis also showed that PDPN knockdown inhibited the viability, adhesive ability, and migratory capacity of CAL-27 and CTSC-3 cells, effects that could be reversed by the application of a miR-532-3p inhibitor. Additionally, PDPN was found to be a direct target of miR-532-3p.

Conclusions:

This research suggested that by targeting PDPN, miR-532-3p could inhibit cell proliferation viability, adhesion, and migration in TSCC. Findings also revealed that the miR-532-3p/PDPN axis might provide more insights into the prognosis and treatment of TSCC.
Nomogram for predicting axillary lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy
Authors: Wang Wenyan , Wang Xin , Liu Jiaqi , Zhu Qiang , Wang Xiang , Wang Pilin
Published: December 2021

Background:

Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.

Methods:

This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.

Results:

In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121–0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123–0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304–0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.

Conclusion:

We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.

Trial registration:

ChiCTR.org.cn, ChiCTR1800014968.
Cognitive impairment in two subtypes of a single subcortical infarction
Authors: Yang Tang , Deng Qiao , Jiang Shuai , Yan Yu-Ying , Yuan Ye , Wu Si-Miao , Zhang Shu-Ting , Sun Jia-Yu , Wu Bo
Published: December 2021

Background:

Single subcortical infarction (SSI) is caused by two main etiological subtypes, which are branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI. We applied the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) to investigate the differences in cognitive performance between these two subtypes of SSI.

Methods:

Patients with acute SSIs were prospectively enrolled. The differences of MoCA-BJ, STT, and SCWT between the BAD group and CSVD-related SSI group were analyzed. A generalized linear model was used to analyze the associations between SSI patients with different etiological mechanisms and cognitive function. We investigated the correlations between MoCA-BJ, STT, and SCWT using Spearman's correlation analysis and established cut-off scores for Shape Trail Test A (STT-A) and STT-B to identify cognitive impairment in patients with SSI.

Results:

This study enrolled a total of 106 patients, including 49 and 57 patients with BAD and CSVD-related SSI, respectively. The BAD group performances were worse than those of the CSVD-related SSI group for STT-A (83 [60.5–120.0] vs. 68 [49.0–86.5], P = 0.01), STT-B (204 [151.5–294.5] vs. 153 [126.5–212.5], P = 0.015), and the number of correct answers on Stroop-C (46 [41–49] vs. 49 [45–50], P = 0.035). After adjusting for age, years of education, National Institutes of Health Stroke Scale and lesion location, the performance of SSI patients with different etiological mechanisms still differed significantly for STT-A and STT-B.

Conclusions:

BAD patients were more likely to perform worse than CSVD-related SSI patients in the domains of language, attention, executive function, and memory. The mechanism of cognitive impairment after BAD remains unclear.
Dorsal root ganglion neurostimulation: a target for treatment for intractable neuropathic itch?
Authors: Hawash Ahmed A. , Kapural Leonardo , Yosipovitch Gil
Published: December 2021

Intractable itch is a severe, relentless, and debilitating chronic itch that is not curable by any known means. Ordinary medical measures usually are not helpful for these patients who often suffer from neural hypersensitization. These patients have often exhausted numerous treatments and still suffer from intractable pruritus. As chronic pain and chronic pruritus share many similarities, the use of medical treatments that reduce neural sensitization in intractable chronic pain may similarly help intractable chronic itch. One of the fastest growing treatments for chronic pain management is spinal neuromodulation. To our knowledge, the use of these modalities has not been applied to chronic intractable itch. The dorsal root ganglion (DRG) has recently become a target for neuromodulation. Through this review, we evaluate the rationale behind the use of the DRG electrical stimulation modality for chronic pain and assess its potential utility for patients with chronic, intractable pruritus. Given the similarities between chronic pain and chronic pruritus and the success of DRG neurostimulation in chronic pain, it may prove worthwhile to explore the efficacy of the modality for specific conditions presenting with chronic intractable pruritus.
A Model of Practices of Exemplary Clinical Education Leaders
Authors: LaFay Vicki , Silberman Nicki , Zeigler Stacey
Published: December 2021

Introduction:

Despite frequent turnover and stress in both Director of Clinical Education (DCE) and Site Coordinator of Clinical Education (SCCE) positions, there are those who demonstrate longevity and success in these roles.

Review of the Literature:

A recent regional investigation found that successful DCEs and SCCEs share characteristics common to exemplary leaders. The purpose of this qualitative study was to confirm if characteristics of DCEs and SCCEs who demonstrate longevity and success are consistent with the 5 Practices of Exemplary Leaders, an established leadership framework.

Subjects:

Directors and Site Coordinators of Clinical Education, recognized by peers as leaders with at least 10 years of experience in their position, were recruited through purposive sampling from regional clinical education consortia.

Methods:

A grounded theory approach was employed to explore qualities, skills and characteristics of DCEs and SCCEs with demonstrated success and longevity in their roles. Cognitive mapping and one-on-one interviews were conducted to explore participants’ perspectives. An inductive approach informed coding and thematic development. The DCE and SCCE data were combined for final thematic analysis.

Results:

Twelve participants completed the study. The findings describe leaders with a firmly established professional identity as a physical therapist and an action-oriented mindset, skilled in creating meaningful relationships, and a capacity to thrive with support. They demonstrate influence and impact the profession on multiple levels.

Discussion/Conclusion:

Results of this study validate that DCEs and SCCEs who demonstrate longevity and success in their roles have common leadership characteristics. A model is presented that describes who these leaders are, what they do, what allows them to reach their potential, and what they can achieve. This model can help identify individuals with the skills and traits to excel in these vital roles.
Effect of Educational Intervention Program on Awareness, Knowledge, Attitude, and Willingness to Recommend Physiotherapy as a Career Among High School Science Teachers
Authors: Akosile Christopher Olusanjo , Mbaneme Nzube Obiefuna , Akobundu Uzoamaka Nwakego , Okoye Emmanuel Chiebuka , Fabunmi Ayodeji Ayodele , Johnson Olubusola Esther
Published: December 2021

Introduction.

Physical therapy (physiotherapy) is an essential part of the health care delivery system. High school students with an interest in science may be suited for a career in health care, including physical therapy. It is important therefore that their teachers have good knowledge and great willingness to recommend physical therapy as a potential career choice to them. Few studies have been carried out on the knowledge about physical therapy among different populations. The previous reports highlighted the need for educational interventions to increase the knowledge about physical therapy. However, no previous study has investigated the effectiveness of these educational interventions. Therefore, this study was aimed at evaluating the effect of an educational intervention in improving the level of knowledge, attitude, and willingness to recommend physical therapy as a potential career choice to students among high (secondary) school science teachers in Nnewi, Anambra State, Nigeria.

Review of Literature.

Few studies have been carried out on the knowledge about physical therapy among different populations. There is need for educational interventions to increase the knowledge about physical therapy. No previous study has investigated the effectiveness of these educational interventions.

Subjects.

Consecutively recruited 99 science teachers from purposively selected high schools.

Methods.

This was a pretest–posttest quasi experimental study. Consecutively recruited 99 science teachers from purposively selected high schools participated in the study. Data were collected preintervention and postintervention using a self-developed instrument.

Results.

Only 20.2% of the participants had a good knowledge of physical therapy on pretest but the proportion with good knowledge increased to 96% after the intervention. Ninety-nine percent of the respondents also developed a positive attitude towards physical therapy and willingness to recommend physical therapy as a potential career choice to their students after the educational intervention.

Discussion and Conclusion.

Awareness of physical therapy among science teachers is poor. The effectiveness of the educational intervention program revealed a role for physical therapists who wish to enhance the awareness of counselors. Well-informed teachers and counselors may be equipped with the required knowledge to guide the career choice of their students.
Association between clinical characteristics and CT findings in patients with coronavirus disease-2019
Authors: Zheng Ting , Ren Hao , Wu Yongjuan , Wang Jiangtao
Published: December 2021

This retrospective study was to investigate the association between clinical characteristics and computerized tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19). The clinical data of COVID-19 patients were retrospectively analyzed. Spearman correlation analysis was used to identify the correlation. Totally 209 consecutive COVID-19 patients were eligible for the study, with the mean age of 47.53 ± 13.52 years. At onset of the disease, the most common symptoms were fever (85.65%) and cough (61.24%). The CT features of COVID-19 included pulmonary, bronchial, and pleural changes, with the significant pulmonary presentation of ground-glass opacification (93.30%), consolidation (48.80%), ground-glass opacification plus a reticular pattern (54.07%), telangiectasia (84.21%), and pulmonary fibrotic streaks (49.76%). Spearman analysis showed that the CT findings had significantly inverse associations with the platelets, lymphocyte counts, and sodium levels, but were positively related to the age, erythrocyte sedimentation rate, D-dimer, lactic dehydrogenase, α-hydroxybutyrate dehydrogenase, and C-reactive protein levels (P < .05). In conclusion, the severity of lung abnormalities on CT in COVID-19 patients is inversely associated with the platelets, lymphocyte count, and sodium levels, whereas positively with the age, erythrocyte sedimentation rate, D-dimer, lactic dehydrogenase, hydroxybutyrate dehydrogenase, and C-reactive protein levels.
Efficacy and safety of combination therapy with pramipexole and levodopa vs levodopa monotherapy in patients with Parkinson disease
Authors: Wang Yan , Jiang De-Qi , Lu Cheng-Shu , Li Ming-Xing , Jiang Li-Lin
Published: December 2021

Background:

Pramipexole (P) or levodopa (L) treatment has been suggested as a therapeutic method for Parkinson disease (PD) in many clinical studies. Nonetheless, the combined effects of 2 drugs for PD patients are not completely understood.

The aim of this research was to evaluate the clinical efficacy and safety of P plus L (P+L) combination therapy in the treatment of PD compared to that of L monotherapy, in order to confer a reference for clinical practice.

Methods:

Randomized controlled trials (RCTs) of P+L for PD published up to April, 2020 were retrieved. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was measured with the I
2 test. Sensitivity analysis was also carried out. The outcomes of interest were as follows: the efficacy, unified Parkinson disease rating scale (UPDRS) scores, Hamilton depression rating scale score or adverse events.

Results:

Twenty-four RCTs with 2171 participants were included. Clinical efficacy of P+L combination therapy was significantly better than L monotherapy (9 trials; OR 4.29, 95% CI 2.78 to 6.64, P < .00001). Compared with L monotherapy, the pooled effects of P+L combination therapy on UPDRS score were (22 trials; SMD −1.31, 95% CI −1.57 to −1.04, P < .00001) for motor UPDRS score, (16 trials; SMD −1.26, 95% CI −1.49 to −1.03, P < .00001) for activities of daily living UPDRS score, (12 trials; SMD −1.02, 95% CI −1.27 to −0.77, P < .00001) for mental UPDRS score, (10 trials; SMD −1.54, 95% CI −1.93 to −1.15, P < .00001) for complication UPDRS score. The Hamilton depression rating scale score showed significant decrease in the P+L combination therapy compared to L monotherapy (12 trials; SMD −1.56, 95% CI −1.90 to −1.22, P < .00001). In contrast to L monotherapy, P+L combination therapy reduced the number of any adverse events obviously in PD patients (16 trials; OR 0.36, 95% CI 0.27 to 0.50, P < .00001).

Conclusions:

P+L combination therapy is superior to L monotherapy for improvement of clinical symptoms in PD patients. Moreover, the safety profile of P+L combination therapy is better than that of L monotherapy. Further well-designed, multicenter RCTs needed to identify these findings.
Determination of risk factors for fever after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma
Authors: Li Jinpeng , Shi Congcong , Shi Jutian , Song Jinlong , Wang Nan
Published: December 2021

This study was to identify risk factors affecting postembolization fever (PEF) of CalliSpheres drug-eluting bead transarterial chemoembolization (DEB-TACE) in the treatment of primary hepatocellular carcinoma (HCC).

One hundred eighty-eight consecutive patients with HCC who underwent DEB-TACE with fever between June 2017 and May 2019 were included in this retrospective study. The patients were divided into 4 groups based on the severity of posttransarterial chemoembolization (TACE) fever according to the degrees of body temperature. Univariate analysis and multivariate logistics regression were performed to identify potential risk factors for post-TACE fever.

In the stepwise multiple regression analysis, pre-TACE blood urea, small particle size and Cental liqefction (P < .05) were independent risk factors of severe post-TACE fever (P < .05, respectively). Portal vein thrombosis (P < .01), Child-Pugh stage (P < .01), and cycles of DEB-TACE (P < .05) were independent risk factors for clinical death, PEF was not associated with clinical death (P = .754) and 6-month survival (P = .524) in the univariate analysis. Moreover, multivariate Cox regression was performed, and Child-Pugh stage (B vs A) (P = .040) and portal vein thrombosis (yes vs no) (P = .033) were independent factors predicting unfavorable overall survival in HCC patients.

Pre-TACE blood urea, small particle size, and Cental liqefction were significantly correlated with the occurrence fever after DEB-TACE. Therefore, these factors should be taken into full consideration for the relief of fever. However, PEF after D-TACE was not associated with clinical death and 6-month survival rate.
Effects of traditional Chinese medicine exercise therapy on cancer-related fatigue, anxiety and sleep quality in cancer patients
Authors: Jiang Lihao , Ouyang Ju , Du Xianfeng
Published: December 2021

Background:

Cancer-related fatigue (CRF) is one of the most common adverse events of anticancer therapies, with an incidence of up to 90%, which seriously affects the quality of life in cancer patients. Complementary and alternative therapies for CRF include acupuncture, Chinese herbal medicine, Tai Chi, Qigong, and massage therapy. Several studies have shown that traditional Chinese medicine (TCM) exercise therapies, such as Tai Chi, Ba Duan Jin, the classics of tendon changing, Six Healing Sounds, and Wu Qin Xi, can improve CRF, anxiety symptoms, and sleep quality in cancer patients. However, their specific efficacy and which TCM exercise therapy is the best remain controversial. In this study, we assess and compare the effects of different TCM exercise therapies on CRF, anxiety, and sleep quality in cancer patients by network meta-analysis (NMA).

Methods:

Randomized controlled trials reporting TCM exercise therapies for CRF, anxiety and sleep quality in cancer patients published before October 2021 will be searched in the PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data. Two researchers will be independently responsible for literature screening, data extraction and assessment of their quality. Standard pair-wise and NMA will be performed to compare the efficacy of different TCM exercise therapies on CRF, anxiety and sleep quality in cancer patients using Stata 14.0 software.

Results:

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

Conclusions:

This NMA will contribute to identify the optimal TCM exercise therapy for CRF and provide evidence-based bias for clinical decision-making.

Ethics and dissemination:

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

OSF REGISTRATION NUMBER:

DOI 10.17605/OSF.IO/MJ8DA.
Prevalence of anxiety, depression, and stress among teachers during the COVID-19 pandemic
Authors: Silva David Franciole Oliveira , Cobucci Ricardo Ney , Lima Severina Carla Vieira Cunha , de Andrade Fábia Barbosa
Published: December 2021

Background:

Identifying the prevalence of anxiety, depression, and stress among teachers during the COVID-19 pandemic.

Methods:

Systematic review of original studies published in any language. Protocol published in PROSPERO under number CRD42021240543. The search was carried out in the Web of Science, PsycINFO, Pubmed, Embase, LILACS, and SciELO databases, using the descriptors: anxiety, depression, stress, teacher, faculty, COVID-19, and their synonyms. Narrative synthesis was carried out in line with the synthesis without meta-analysis in systematic reviews.

Results:

Of the 1372 records identified, 6 studies, all cross-sectional, were included in the review. The studies were carried out in China, Brazil, the United States of America, India, and Spain. Five studies included more women than men. The participants were aged from 24 to 60 years. Three studies included only school teachers, 2 included schools and universities teachers, and 1 only university teachers. Of the 5 studies, all dealt with remote activities and only 1 included teachers who returned to face-to-face classes 1 to 2 weeks ago. The prevalence of anxiety ranged from 10% to 49.4%, and depression from 15.9% to 28.9%, being considerably higher in studies with teachers who worked in schools. The prevalence of stress ranged from 12.6% to 50.6%.

Conclusion:

The prevalence of anxiety, depression, and stress was high among teachers during the pandemic, with great variation between studies. Anxiety and stress were more prevalent in the Spanish study. The results show the need for measures for the care of teachers’ mental health, especially when returning to face-to-face classes.
Rebound of platelet count in a patient with type 2 calreticulin-mutant essential thrombocythemia in the postpartum period
Authors: Al-Mashdali Abdulrahman F. , Yassin Mohamed A.
Published: December 2021

Introduction:

Essential thrombocythemia (ET) is an uncommon myeloproliferative neoplasm. It is more common in females; 20% of them are below 40 years old. The optimal management of ET during pregnancy and postpartum periods is still not well established.

Patient concern:

We report a case of a young lady with type 2 calreticulin-mutant ET who developed a marked rebound in her platelet count (reaching 2030 × 103/μL) 2 weeks after premature delivery of her baby (24th week of gestation). She was on Pegylated Interferon alfa 2-a during pregnancy (her platelet was around 500 × 103/μL during the second trimester), but she had stopped it on her own from the 20th week of gestation.

Diagnosis:

Postpartum rebound of platelet count due to medication non-compliance.

Intervention and outcome:

We resumed her regular Pegylated Interferon, and subsequently, her platelet count reduced dramatically within 4 weeks to an acceptable level (684 × 103 /μL).

Conclusion:

The guideline is still not well-established regarding the optimal approach for postpartum rebound of platelet count in patients with ET. It is still unclear if the platelet count will fall spontaneously without intervention after the rebound phase. Further research is required to establish the optimal management of ET during the postpartum phase. This case emphasizes the importance of platelet count follow-up during the postpartum period and outlines our management approach in such cases.
IgA vasculitis mimicking drug-induced skin reaction and infectious colitis in an elderly patient
Authors: Yim Sung Kyun , Seo Seung Young
Published: December 2021

Rationale:

Immunoglobulin A vasculitis (IgAV) in adults is rare and shows worse symptoms and prognosis. In real-life clinics, IgAV in elderly patients may be difficult to diagnose because of its rarity and other common diseases to consider. This study reports a case of IgAV mimicking drug-induced skin reaction in an elderly patient.

Patient concerns:

A 74-year-old female without any underlying disease presented to our emergency department as she was suffering from lower abdominal pain and diarrhea for 3 weeks. The patient was diagnosed with infectious colitis, and antibiotic treatment was administered at a local clinic. At presentation, the patient had rashes on both lower legs that developed after the antibiotic treatment, which was assumed as a drug eruption. Although antibiotic treatment was continued, the patient had persistent abdominal pain, diarrhea, hematochezia, and rashes. Proteinuria was developed on urinalysis.

Diagnoses:

Infectious colitis, IgAV.

Interventions:

Sigmoidoscopy revealed easily bleeding erythematous mucosal lesions from the descending colon to the rectum. IgAV was suspected, and thus skin biopsy was performed. Histological findings of the skin biopsy showed leukocytoclastic vasculitis, which is compatible with IgAV. A nonsteroidal anti-inflammatory drug was administered for abdominal pain. The patient showed persistent proteinuria and a systemic steroid (prednisolone 50 mg [1 mg/kg]) was started.

Outcomes:

After administration of the nonsteroidal anti-inflammatory drug, the patient's abdominal pain was resolved rapidly. Under systemic steroid treatment, the patient showed significant symptomatic improvements, and after 2 weeks, the skin and colonic mucosal lesions were completely resolved.

Lessons:

We present a case of adult-onset IgAV, which was initially diagnosed with infectious colitis and drug eruption. The history of skin reaction development after antibiotic treatment and the rarity of IgAV in elderly patients masked the diagnosis of IgAV. Despite its rarity, IgAV should be highly suspected in elderly patients with rashes, proteinuria, and signs of colitis.
Erlotinib combined with bevacizumab and chemotherapy in first line osimertinib-resistant NSCLC patient with leptomeningeal metastasis
Authors: Wang Musen , Zhu Fuxin , Luo Ningning , Li Mengmeng , Qi Yingxue , Wang Mingbo
Published: December 2021

Rationale:

Leptomeningeal metastasis (LM) is a fatal complication of advanced non-small cell lung cancer (NSCLC) with a poor prognosis. Osimertinib is a promising option for NSCLC with LM harboring epidermal growth factor receptor (EGFR) mutation. However, therapeutic approaches remain a challenge for osimertinib resistant NSCLCs with LM. Although studies have reported that the first/second-generation EGFR-tyrosine kinase inhibitors were active against osimertinib-resistant NSCLC with EGFR C797S and sensitive mutation (SM), the resistance inevitably occurred due to the development of the EGFR SM/C797S/T790M triple mutations.

Patient concerns:

A 48-year-old woman was diagnosed with stage IV lung adenocarcinoma harboring the EGFR mutation in the combination of chest computed tomography, biopsy and amplification refractory mutation system-polymerase chain. One year and a half after oral administration of osimertinib, the patient progressed to extensive LM.

Diagnoses:

Magnetic resonance images of the brain showed extensive LM. Exfoliated tumor cells from cerebrospinal fluid (CSF) were positive detected by lumbar puncture and the cytology examination. EGFR mutations (exon19 E746_T751delinsI and exon20 C797S) in CSF circulating tumor DNA were detected by next-generation sequencing (NGS).

Interventions:

Pemetrexed (800 mg day 1), cis-platinum (40 mg day 1-3) combined with bevacizumab (400 mg day 1) every 3 weeks were administered to the patient. After 1 cycle, due to optic nerve invasion, erlotinib was applied 150 mg/d combined with previous regimen. The patient continued erlotinib monotherapy after 6 cycles.

Outcomes:

After LM, erlotinib combined with pemetrexed, cis-platinum and bevacizumab were administered to the patient for 4.25 months based on the CSF NGS. Then, the patient continued erlotinib monotherapy and appeared disease progression after 10 months. The overall survival is 35 months.

Lessons:

LM is a fatal complication of advanced NSCLC with a poor prognosis. NGS profiling of CSF circulating tumor DNA is important in NSCLC patients with LM and erotinib plus bevacizumab and chemotherapy is a promising option for patients with LM harboring EGFR C797S/SM.
Primary nasopharyngeal papillary adenocarcinoma
Authors: Shen Chih-Hsuan , Chang Shih-Lun , Chang Sheng-Tsung
Published: December 2021

Rationale:

Primary nasopharyngeal papillary adenocarcinoma is a rare nasopharyngeal neoplasm with a good prognosis and a low propensity for regional recurrence. To date, only few cases of primary nasopharyngeal papillary adenocarcinoma have been reported in the literature.

Patient concerns:

A 24-year-old female patient presented with intermittent hemoptysis and blood tinge nasal discharge.

Diagnosis:

An exophytic and pedunculated mass over the roof of the nasopharynx was found on nasopharyngoscope. Biopsy was done and the pathology confirmed well-differentiated primary nasopharyngeal papillary adenocarcinoma, strongly positive for CK7, and transcription termination factor 1; but negative for thyroglobulin. The final diagnosis was primary nasopharyngeal papillary adenocarcinoma, well-differentiated, pT1N0M0, stage I.

Interventions:

The patient underwent excision of nasopharyngeal tumor under sinuscopic assistance.

Outcomes

: No local recurrence or distant metastasis was noted during the 6 months of follow-up.

Lessons:

We aim at highlighting the importance of a thorough differential diagnosis of nasopharyngeal tumor. Further investigation is still needed for providing evidence to standardize the treatment protocol.
Efficacy and safety of hematopoietic stem cell transplantation for hematologic malignancies
Authors: Ji Cong-hua , Dai Rong-chen , Wu Han-ting , Li Qiu-shuang , Liu Shan , He Pei-jie , Liang Juan
Published: December 2021

Introduction:

Hematopoietic stem cell transplantation is an essential and often the sole treatment strategy for relapsed and refractory hematologic malignancies (HMs). More and more systematic reviews and meta-analysis of clinical trials have investigated the effects of hematopoietic stem cell transplantation in patients with HMs. In order to systematically appraise and synthesize these results, we will conduct an overview of systematic review and meta-analysis.

Methods:

This is a protocol for an overview of systematic reviews and meta-analysis. We will search eight databases: PubMed, Embase, Cochrane Library, Web of Science Core Collection, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Chinese Scientific Journals Database and Wan Fang Data. The time is limited from the construction of the library to May 2021.Systematic reviews and meta-analysis of clinical trials evaluating the efficacy and safety of hematopoietic stem cells in patients with HMs will be included. Hematopoietic stem cells included bone marrow, peripheral blood stem cells and cord blood stem cells. Patients with HMs including leukemia, malignant lymphoma, myelodysplastic syndrome, etc. Two independent authors will screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full text review. The methodological quality of the included reviews will be assessed using A Measurement Tool to Assess Systematic Reviews-2. The efficacy and safety of different stem cell types in the treatment of the same hematological disease and the same stem cell type in the treatment of different HMs will be analyzed. Additionally, the quality of evidence will use the Grading of Recommendations Assessment, Development and Evaluation system. Our reviewers will conduct systematic reviews, qualification evaluation, data extraction, methodological quality and evidence quality screening in pairs.

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

This overview will provide comprehensive evidence for hematopoietic stem cell transplantation in patients with HMs.

Protocol Registration:

INPLASY202150064.
Different Transfer Forms of the Expanded Forehead Flap Pedicled With Superficial Temporal Vessels to Treat Chin and Submental Scar Deformities
Authors: Cao Zilong , Liu Liqiang , Fan Jincai , Tian Jia , Gan Cheng , Jiao Hu , Yang Zengjie
Published: December 2021

Background:

The chin and submental regions are located at the junction of the face and neck. Its function and aesthetic appearance can be seriously affected when scar deformities cause the cervico-mental angle to disappear. The expanded forehead flap pedicled with superficial temporal vessel(s) is a surgical treatment for chin and submental scar deformities. Different transfer types have developed for this flap based on individual situations. At present, there is no unified treatment strategy for applying this forehead flap to treat different regions and ranges of chin and submental scar deformities.

Methods:

Ninety one cases were collected from patients with chin and submental scar deformities that were treated using the expanded forehead flap pedicled with superficial temporal vessels from January 2008 to December 2018. The authors divided the chin and submental scar deformities into 4 types according to different regions and ranges, and summarized flap survival and complications of 5 different transfer forms used to treat scars for creating feasible treatment strategies. We followed up 76 cases, investigating the satisfaction of appearance and texture of the flaps, improvement of neck movement, and scar recurrence.

Results:

Expanded forehead flaps were used to repair 91 cases of chin and submental scar deformities. According to the postoperative flap survival and complications of flap blood supply, the treatment strategies are as follows: Bilateral cutaneous and subcutaneous pedicled forehead flaps are applied to treat scars in bilaterally symmetrical large-scale scars in Zone LCL. Unilateral pedicled forehead flaps are applied to treat small-scale scars in Zone C and Zone L. Unilateral pedicled plus contralateral vascular anastomosis and unilateral pedicled plus contralateral super thin forehead flaps are applied to treat the moderate-scale scars of Zone LC. Mean follow-up period was 81 months (range 28–131), 93.4% (71/76) was satisfied with appearance and texture of the flaps, 97.4% (74/ 76) was satisfied with the improvement of neck movement, and 2.6% (2/76) occurred scar recurrence.

Conclusions:

Five different types of expanded forehead flaps pedicled with superficial temporal vessels can be used to repair differential scar deformities of the chin and submental regions and achieve good therapeutic effects.
Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator, Trauma and Injury Severity Score, and American Society of Anesthesiologists Physical Status to predict operative trauma mortality in elderly patients
Authors: Stopenski Stephen , Kuza Catherine M. , Luo Xi , Ogunnaike Babatunde , Ahmed M. Iqbal , Melikman Emily , Moon Tiffany , Shoultz Thomas , Feeler Anne , Dudaryk Roman , Navas Jose , Vasileiou Georgia , Yeh D. Dante , Matsushima Kazuhide , Forestiere Matthew , Lian Tiffany , Hernandez Oscar , Ricks-Oddie Joni , Gabriel Viktor , Nahmias Jeffry
Published: December 2021

BACKGROUND

The Trauma and Injury Severity Score (TRISS) uses anatomical and physiologic variables to predict mortality. Elderly (65 years or older) trauma patients have increased mortality and morbidity for a given TRISS, in part because of functional status and comorbidities. These factors are incorporated into the American Society of Anesthesiologists Physical Status (ASA-PS) and National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC). We hypothesized scoring tools using comorbidities and functional status to be superior at predicting mortality, hospital length of stay (LOS), and complications in elderly trauma patients undergoing operation.

METHODS

Four level I trauma centers prospectively collected data on elderly trauma patients undergoing surgery within 24 hours of admission. Using logistic regression, five scoring models were compared: ASA-PS, NSQIP-SRC, TRISS, TRISS–ASA-PS, and TRISS–NSQIP-SRC.

Brier scores and area under the receiver operator characteristics curve were calculated to compare mortality prediction. Adjusted R
2 and root mean squared error were used to compare LOS and predictive ability for number of complications.

RESULTS

From 122 subjects, 9 (7.4%) died, and the average LOS was 12.9 days (range, 1–110 days). National Surgical Quality Improvement Program Surgical Risk Calculator was superior to ASA-PS and TRISS at predicting mortality (area under the receiver operator characteristics curve, 0.978 vs. 0.768 vs. 0.903; p = 0.007). Furthermore, NSQIP-SRC was more accurate predicting LOS (R
2, 25.9% vs. 13.3% vs. 20.5%) and complications (R
2, 34.0% vs. 22.6% vs. 29.4%) compared with TRISS and ASA-PS. Adding TRISS to NSQIP-SRC improved predictive ability compared with NSQIP-SRC alone for complications (R
2, 35.5% vs. 34.0%; p = 0.046). However, adding ASA-PS or TRISS to NSQIP-SRC did not improve the predictive ability for mortality or LOS.

CONCLUSION

The NSQIP-SRC, which includes comorbidities and functional status, had superior ability to predict mortality, LOS, and complications compared with TRISS alone in elderly trauma patients undergoing surgery.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III
Emergency medical services shock index is the most accurate predictor of patient outcomes after blunt torso trauma
Authors: Bardes James M. , Price Bradley S. , Adjeroh Donald A. , Doretto Gianfranco , Wilson Alison
Published: December 2021

INTRODUCTION

Shock index (SI) and delta shock index (∆SI) predict mortality and blood transfusion in trauma patients. This study aimed to evaluate the predictive ability of SI and ∆SI in a rural environment with prolonged transport times and transfers from critical access hospitals or level IV trauma centers.

METHODS

We completed a retrospective database review at an American College of Surgeons verified level 1 trauma center for 2 years. Adult subjects analyzed sustained torso trauma. Subjects with missing data or severe head trauma were excluded. For analysis, poisson regression and binomial logistic regression were used to study the effect of time in transport and SI/∆SI on resource utilization and outcomes. p < 0.05 was considered significant.

RESULTS

Complete data were available on 549 scene patients and 127 transfers. Mean Injury Severity Score was 11 (interquartile range, 9.0) for scene and 13 (interquartile range, 6.5) for transfers. Initial emergency medical services SI was the most significant predictor for blood transfusion and intensive care unit care in both scene and transferred patients (p < 0.0001) compared with trauma center arrival SI or transferring center SI. A negative ∆SI was significantly associated with the need for transfusion and the number of units transfused. Longer transport time also had a significant relationship with increasing intensive care unit length of stay. Cohorts were analyzed separately.

CONCLUSION

Providers must maintain a high level of clinical suspicion for patients who had an initially elevated SI. Emergency medical services SI was the greatest predictor of injury and need for resources. Enroute SI and ∆SI were less predictive as time from injury increased. This highlights the improvements in en route care but does not eliminate the need for high-level trauma intervention.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.
Damage-control surgery in patients with nontraumatic abdominal emergencies: A systematic review and meta-analysis
Authors: Haltmeier Tobias , Falke Monika , Quaile Oliver , Candinas Daniel , Schnüriger Beat
Published: December 2021

BACKGROUND

After the successful implementation in trauma, damage-control surgery (DCS) is being increasingly used in patients with nontraumatic emergencies. However, the role of DCS in the nontrauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with nontraumatic abdominal emergencies.

METHODS

Systematic literature search was done using PubMed. Original articles addressing nontrauma DCS were included. Two meta-analyses were performed, comparing (1) mortality in patients undergoing nontrauma DCS versus conventional surgery (CS) and (2) the observed versus expected mortality rate in the DCS group. Expected mortality was derived from Acute Physiology And Chronic Health Evaluation, Simplified Acute Physiology Score, and Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity scores.

RESULTS

A total of five nonrandomized prospective and 16 retrospective studies were included. Nontrauma DCS was performed in 1,238 and nontrauma CS in 936 patients. Frequent indications for surgery in the DCS group were (weighted proportions) hollow viscus perforation (28.5%), mesenteric ischemia (26.5%), anastomotic leak and postoperative peritonitis (19.6%), nontraumatic hemorrhage (18.4%), abdominal compartment syndrome (17.8%), bowel obstruction (15.5%), and pancreatitis (12.9%). In meta-analysis 1, including eight studies, mortality was not significantly different between the nontrauma DCS and CS group (risk difference, 0.09; 95% confidence interval, −0.06 to 0.24). Meta-analysis 2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing nontrauma DCS (risk difference, −0.18; 95% confidence interval, −0.29 to −0.06).

CONCLUSION

This meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS versus CS. However, observed mortality was significantly lower than the expected mortality rate in the DCS group, suggesting a benefit of the DCS approach. Based on these two findings, the effect of DCS on mortality in patients with nontraumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level III.
Phenotypic detection, antimicrobial susceptibility and virulence profile of staphylococci in the pig production setting, Makurdi, Nigeria
Authors: Mamfe Levi M. , Akwuobu Chinedu A. , Ngbede Emmanuel O.
Published: December 2021

Livestock, particularly pigs, have increasingly been recognized as important reservoirs for zoonotic transmission of pathogenic bacteria, including staphylococci. Livestock production systems in developing countries of sub-Saharan Africa, including Nigeria, are characterized by high misuse/abuse of antimicrobials and a close association between humans and these animals, which promotes the emergence and transmission of resistant and potentially virulent bacteria. In the present study, we investigated the occurrence and characteristics (species distribution, virulence and resistance profile) of staphylococci from smallholder backyard pig farms, slaughter slabs and pig handlers in Makurdi, Nigeria. A total of 330 nasal swabs originating from 300 pigs and 30 in-contact humans were collected and processed. One hundred and thirteen samples [34.2 %; 95 % confidence interval (CI): 29.1–39.6] comprising 103 (34.3 %; 95 % CI: 29.0–40.0) and 10 (33.3 %; 95 % CI: 17.3–52.8 %) samples from pigs and humans, respectively, were positive for staphylococci, yielding 120 isolates (pigs n=110, humans n=10). The 120 isolates were distributed into 15 species with

Staphylococcus aureus

(n=25) followed by

Staphylococcus cohnii

(n=19) and

Staphylococcus sciuri

(n=14) occurring more frequently. All isolates were resistant to β-lactam (100 %) antibiotics. Resistance to some critical antimicrobials, including linezolid (22 %), vancomycin (19.2 %), gentamicin (7.5%) and the fluoroquinolones ciprofloxacin (75.8 %) and enrofloxacin (66.7 %), was also observed. Majority (99.2 %) of the isolates displayed a multidrug resistance phenotype with the AMP-C-CIP-E-ENR-FOX-OX-P-S-SXT-TE phenotype being predominant. Overall, 70 % of the isolates expressed the methicillin resistance phenotype, out of which 20 % (n=17) were MRSA. Resistance to serum bactericidal activity and biofilm production were respectively observed in 45 (100 %) and 5 (11.3 %) of the coagulase-positive staphylococci. Our findings demonstrated the occurrence of a high diversity of staphylococci expressing multidrug resistance and potentially virulent phenotypes among healthy swine and pig handlers in small-scale backyard farms in North-Central Nigeria. These findings underscore the potential role of pig production settings in the emergence and dissemination of potentially virulent staphylococci and the importance of the development of antimicrobial resistance monitoring systems/implementation of control measures in developing countries. Proper hygienic practices and control of indiscriminate use and misuse of antibiotics are recommended.
Xanthobacter dioxanivorans sp. nov., a 1,4-dioxane-degrading bacterium
Authors: Wang Yingning , Ma Fang , Yang Jixian , Guo Haijuan , Su Delin
Published: December 2021

A Gram-stain-negative bacterium, designated as YN2T, that is capable of degrading 1,4-dioxane, was isolated from active sludge collected from a wastewater treatment plant in Harbin, PR China. Cells of strain YN2T were aerobic, motile, pleomorphic rods, mostly twisted, and contained the water-insoluble yellow zeaxanthin dirhamnoside. Strain YN2T grew at 10–40 °C (optimum, 30 °C), pH 5.0–8.0 (pH 7.0) and with 0–1 % (w/v) NaCl (0.1 %). It also could grow chemolithoautotrophically and fix N2 when no ammonium or nitrate was supplied. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain YN2T belongs to the genus

Xanthobacter

and shares the highest pairwise identity with

Xanthobacter autotrophicus

7cT (98.6 %) and

Xanthobacter flavus

301T (98.4 %). The major respiratory quinone was ubiquinone-10. Chemotaxonomic analysis revealed that the strain possesses C16 : 0, C19 : 0 cyclo ω8c and C18 : 1 ω7c as the major fatty acids. The DNA G+C content was 67.95 mol%. Based on genome sequences, the DNA–DNA hybridization estimate values between strain YN2T and

X. autotrophicus

7cT,

X. flavus

301T and

X. tagetidis

TagT2CT (the only three species of

Xanthobacter

with currently available genomes) were 31.70, 31.30 and 28.50 %; average nucleotide identity values were 85.23, 84.84 and 83.59 %; average amino acid identity values were 81.24, 80.23 and 73.57 %. Based on its phylogenetic, phenotypic, and physiological characteristics, strain YN2T is considered to represent a novel species of the genus

Xanthobacter

, for which the name Xanthobacter dioxanivorans sp. nov. is proposed. The type strain is YN2T (=CGMCC 1.19031T=JCM 34666T).