bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertension, remnant cholesterol and cardiovascular disease: evidence from the China health and retirement longitudinal study
Authors: Zheng Xiaowei , Han Longyang , Shen Suwen
Published: August 2022

Objective:

Previous studies had reported the significant association between hypertension, remnant cholesterol (RC) and risk of cardiovascular disease (CVD). The aim of present study was to evaluate the combined effect of hypertension and RC on the risk of CVD.

Methods:

A total of 9456 participants from the China Health and Retirement Longitudinal Study were included. Multivariate Cox proportional hazards regression model was used to explore the associations between hypertension, RC and new-onset CVD, stroke and cardiac events.

Results:

During the follow-up period, 1702 CVD events (including 563 stroke and 1282 cardiac events) were recorded. Compared to those without hypertension and low RC level, the adjusted hazard ratios (95% confidence intervals) were 1.09 (0.95–1.24) for individuals with high RC alone, 1.27 (1.10–1.46) for individuals with hypertension alone and 1.32 (1.15–1.51) for individuals with comorbid hypertension and high RC. Individuals with co-existence of hypertension and high RC also had the highest risks of stroke and cardiac events.

Conclusion:

Our study indicated that there was a combined effect of hypertension and RC on the risk of CVD, stroke and cardiac events. Larger-sample prospective cohort studies are still required to test the potential application of combination of hypertension and RC as a screening method to identify individuals at risk of CVD.
Side Effects and Complications Associated with Treating Plutonium Intakes: A Retrospective Review of the Medical Records of LANL Employees Treated for Plutonium Intakes, with Supplementary Interviews
Authors: Glover Lauren , Bertelli Luiz , Dumit Sara , Poudel Deepesh , Smith Lauren , Waters Tom , Klumpp John
Published: August 2022

Anecdotal evidence indicates there may be unpublished physical and psychological events associated with the medical treatment of plutonium intakes. A thorough review was conducted of the medical and bioassay records of current and previous Los Alamos National Laboratory (LANL) employees who had experienced plutonium intakes via wound or inhalation. After finding relatively incomplete information in the medical records, the research team interviewed current LANL employees who had undergone chelation therapy and/or surgical excision. Although the dataset is not large enough to reach statistically significant conclusions, it was observed that adverse events associated with treatment appear to be more frequent and more severe than previously reported.
Bicarbonate Effects on Antibacterial Immunity and Mucus Glycobiology in the Cystic Fibrosis Lung: A Review With Selected Experimental Observations
Authors: Siew Ruth , Ou Tzung-Lin , Dahesh Samira , Akong Kathryn , Nizet Victor
Published: August 2022

The primary defect in cystic fibrosis (CF) is abnormal chloride and bicarbonate transport in the CF transmembrane conductance regulator epithelial ion channel. The apical surface of the respiratory tract is lined by an airway surface liquid (ASL) layer composed of mucin comprising mainly MUC5A and MUC5B glycoproteins. ASL homeostasis depends on sodium bicarbonate secretion into the airways and secretion deficits alter mucus properties leading to airway obstruction, inflammation and infections. Downstream effects of abnormal ion transport in the lungs include altered intrinsic immune defenses. We observed that neutrophils killed Pseudomonas aeruginosa more efficiently when it had been exposed to sodium bicarbonate, and formation of neutrophil extracellular traps by neutrophils was augmented in the presence of increasing bicarbonate concentrations. Physiological levels of bicarbonate sensitized P. aeruginosa to the antimicrobial peptide cathelicidin LL-37, which is present in both lung ASL and neutrophil extracellular traps. Sodium bicarbonate has various uses in clinical medicine and in the care of CF patients and could be further explored as a therapeutic adjunct against Pseudomonas infections.
A Pragmatic Study on Nurse-Led Home Phototherapy
Authors: Matthews Sarah W. , Binick Stephanie , Sherman Karen J. , Chien Andy J.
Published: August 2022

BACKGROUND

Narrowband ultraviolet phototherapy is a safe and effective treatment option for chronic skin conditions. The requirements of clinic-based phototherapy can be burdensome, with home-based phototherapy as a reasonable alternative.

OBJECTIVE

This study aimed to analyze the effects of a nurse-led home phototherapy program and describe the clinical resources required.

METHODS

A pragmatic multicenter prospective observational cohort study was conducted from 2019 to 2021. Eighteen participants were enrolled in the program and followed for 9 months. Outcome measures included clearance rates, erythema incidence, Dermatology Life Quality Index, the burden of treatment scores, dermatologic medication usage, and clinic contacts.

RESULTS

Fourteen of the 18 patients (77.8%) reported high skin clearance. Mild erythema was common, moderate erythema was rare, and two episodes of severe erythema were recorded overall. Dermatology Life Quality Index and burden of treatment impact were minimal. Adjunct topical medications decreased by half. Nurses successfully reached participants up to the 3-month time point, with completed contacts decreasing over time. Unplanned contacts included phone calls and emails.

CONCLUSION

Dermatology nurses possess the skills needed to lead safe and effective home phototherapy programs. Although this pragmatic study was small, results are optimistic for the future of nurse-led home phototherapy.
Kidney Function in Factory Workers Exposed to Heat Stress
Authors: Nerbass Fabiana B. , Moist Louise , Vieira Marcos A. , Pecoits-Filho Roberto
Published: August 2022

Objectives

The aims of the study are to re-evaluate kidney function in workers exposed and not exposed to heat stress after 2 years and to compare kidney function cross-shift using creatinine and cystatin C.

Methods

Participants were workers from a metallurgical industry. The clinical and biochemical markers of hydration and kidney function were evaluated before and after a single shift in work.

Results

We included 14 workers (6 in the heat group and 8 in the control group). The serum creatinine levels did not change during the follow-up period. Cross-shift, creatinine-based eGFR (estimated glomerular filtration rate) decreased, and cystatin C-based eGFR was maintained in the heat and control groups.

Conclusions

Workers exposed to heat stress maintained their kidney function after a 2-year follow-up. Cystatin C is a better kidney function marker than creatinine for cross-shift assessments in this setting.
Neoadjuvant therapy for resectable pancreatic cancer: a narrative review
Authors: Wang Chengfang , Wu Yingsheng , Wang Weilin
Published: August 2022

The use of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma remains controversial and limited. Therefore, this literature review aimed to assess the feasibility, safety, and efficacy of this treatment. A database search of peer-reviewed articles published in English between January 1990 and June 2021 in PubMed, MEDLINE, and the Web of Science was performed. Original articles, review articles, and meta-analyses relevant to the topic were selected. We found 2 to 4 cycles with FOLFIRINOX, gemcitabine plus nab-paclitaxel, gemcitabine plus S-1, or gemcitabine alone were the most acceptable treatments. Considering the risk of adverse events and cancer progression, NAT is considered safe and tolerable, with a comparable resection rate. Although NAT can result in moderate tumor responses and some extent of local control (improvement of complete resection rate and negative lymph node metastases), no obvious survival benefit is observed. To date, the survival benefits of NAT for resectable pancreatic ductal adenocarcinoma have been very limited. It is too early to say that NAT is the best treatment option for resectable pancreatic cancer.
Nosocomial infections during extracorporeal membrane oxygenation
Authors: Martínez-Martínez María , Nuvials Francesc Xavier , Riera Jordi
Published: August 2022

Purpose of the review

The aim of this review is to present the latest evidence regarding the prevention, diagnosis and treatment of nosocomial infections during extracorporeal membrane oxygenation (ECMO) support.

Recent findings

New descriptive data from the Extracorporeal Life Support Organisation (ELSO) registry and single centre studies have been published. In parallel, there is an increase in the availability of evidence about the diagnostic accuracy of infection markers, yield of routine cultures, effectivity of antibiotic prophylaxis and other preventive measures.

ECMO is a rescue therapy for severe hemodynamic or respiratory failure. Nosocomial infections on ECMO support are frequent (infection rate ranging between 20.5% to more than 50% of ECMO runs) and have impact in survival, with reported increases in the risk of death up to 63% in infected patients. However, diagnosis and treatment are challenging, as the unique relationship between patient and circuit may act as a confounder for infection and exacerbate the variability of antibiotic pharmacokinetics in critical illness. Clinical practice regarding antibiotic treatment and infection prevention is not yet supported by high-quality evidence.
Long-term recovery after critical illness in older adults
Authors: Kaushik Ramya , Ferrante Lauren E.
Published: August 2022

Purpose of review

The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge.

Recent findings

A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved.

Recent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.
The effect of electromagnetic field on sleep of patients with nocturia
Authors: Chen Shin-Hong , Chin Wei-Chih , Huang Yu-Shu , Chuech Leonard S. , Lin Chang-Min , Lee Chin-Pang , Lin Huang-Li , Tang I , Yeh Ting-Chun
Published: August 2022

Introduction:

Accumulated studies revealed that electromagnetic field can affect human brain and sleep. We explored the effectiveness of electromagnetic field [Schumann resonance (SR)] on nocturia symptoms, quality of life, and sleep in patients with nocturia.

Methods:

This is a randomized, open-label, and active-controlled study, in which 35 participants were randomized into 2 groups. Group A received oxybutynin and the SR device for 12 weeks, while the active-control group received only the medication. We followed these patients every 4 weeks with a number of questionnaires, including the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) for sleep, the American Urological Association Symptom Score (AUASS) for nocturia symptoms, and the Nocturia-Quality-of-Life-questionnaire (N-QOL) for quality of life. Descriptive statistics, pair t-tests, Chi-squared tests, and repeated measures were applied for data analysis.

Results:

No significant difference was found in the demographic data between the 2 groups. The AUASS, N-QOL, PSQI, and ESS total scores were significantly improved in the SR-sleep-device group (P < .001, P = .005, P < .001, P = .001) after treatment, but no significant change was found in the active-control group. Several variables of AUASS in the SR-sleep-device group were significantly improved, especially streaming and sleeping (both P = .001), and subjective sleep quality and sleep efficiency also demonstrated significant improvement (both P < .001).

Conclusions:

Our study revealed that electromagnetic field (SR) as an add-on can improve not only sleep and quality of life but also nocturia symptoms in patients with nocturia. These findings suggest that SR can be effective for sleep disturbance secondary to physical disease, which can be a new application of the electromagnetic field.
Linear indices of ventricular volume on brain computed tomography as markers of effectiveness of epidural blood patch for spontaneous intracranial hypotension: A case report
Authors: Lee So Young , Park Bum Young , Ryu Taeha , Lee Ji Hyeon , Kim Dong Hyuck , Roh Woon Seok
Published: August 2022

Rationale:

Epidural blood patch (EBP) is an effective treatment for spontaneous intracranial hypotension (SIH). However, its effectiveness can only be judged through subjective symptom improvement; no objective markers have been reported. Linear indices of ventricular volume on brain computed tomography (CT) may aid the objective evaluation of the effectiveness of EBP in patients with SIH.

Patient concerns:

A 45-year-old man was hospitalized due to a 3-week history of orthostatic headache, dizziness, and neck pain. He had visited a local emergency department at symptom onset. His neurological examination results were normal and vital signs were stable.

Diagnoses:

Brain magnetic resonance imaging (MRI) revealed pachymeningeal enhancement in both convexities with a small subdural hematoma (SDH). Based on the clinical features and MRI findings, he was diagnosed with SIH complicated by SDH.

Interventions:

Non-targeted EBP was performed, first at the lumbar level and subsequently at the thoracic level. Linear indices of ventricular volume, including the Evans’ index, frontal–occipital horn ratio, and bicaudate index, were measured through brain CT performed before and after EBP.

Outcomes:

After lumbar EBP, there was no symptom relief or increase in linear indices of ventricular volume on brain CT. In contrast, the patient’s symptoms completely resolved and the linear indices of ventricular volume increased after thoracic EBP.

Lessons:

The effectiveness of EBP, which is currently evaluated solely based on changes in symptom severity, can be assessed using linear indices of ventricular volume.
Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report
Authors: Jinghong Yao , Junaid Irshad Muhammad , Irshad Moin , Khalil Ibrahim , Zahoor Shiza , Akram Muhammad , Muddasar Saeed Muhammad , Jafari-Sales Abolfazl , Elbossaty Walaa Fikry , Said Mourad Ben , Aharwal Ravindra Prasad , Hamid Gamal Abdul , Mbaye El Hadji Seydou , El-Ashram Saeed , Ataa Asaad Mohammed A. , Kiliç Ömer
Published: August 2022

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers.

Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples.

All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder.

The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.
Real-world efficacy of sequential nivolumab for metastatic renal cancer after first-line molecular targeting therapy
Authors: Obinata Daisuke , Funakoshi Daigo , Sakurai Fuminori , Yoshizawa Tsuyoshi , Mochida Junichi , Yamaguchi Kenya , Takahashi Satoru
Published: August 2022

This study aimed to clarify the real-world efficacy of sequential nivolumab for treating metastatic renal cancer after first-line molecular targeting therapy.

Patients were divided into two groups (2014–2016 and 2017–2020) according to the year when they started primary treatment with molecular targeted drugs (MTDs). We compared the overall survival of patients and investigated a contributing factor for survival.

The mean duration of overall survival was significantly longer in the 2017–2020 group (44.0 months) than in the 2014–2016 group (8.5 months). Univariate analysis showed that nivolumab treatment was a significant prognostic factor (P = .0021). Patients treated with nivolumab as second-line therapy had a significantly higher 5-year survival rate compared to that of other patients (70% vs 32%). In addition, the time from commencement of MTDs to switch to nivolumab was significantly shorter in the 2017–2020 group compared to the 2014–2016 group (8.94 vs 34.12 months, P = .03).

In our study, cases with first-line MTDs had markedly prolonged outcomes after the 2017 guideline update, and sequential nivolumab with prompt switching to nivolumab was an important factor.
Exploring the mechanism of Buyang Huanwu decoction in the treatment of lumbar disc herniation based on network pharmacology and molecular docking
Authors: Gu Yong , Zhu Haijia , Wang Xiaojian , Zhang Shanxing , Tong Peijian , Lv Shuaijie
Published: August 2022

Buyang Huanwu decoction (BYHWD), as one of the traditional Chinese medicine formulas, is widely used in the clinical treatment of lumbar disc herniation (LDH) with curative effect. It has the characteristics of multi-component, multi-target, and mutual synergy, but the mechanism of action is often unclear. It needs some research to explore the molecular mechanism of BYHWD in the treatment of LDH based on network pharmacology and molecular docking. Screen the active compounds of BYHWD and predict drug-related gene/protein targets, which could determine the specific target of BYHWD in the treatment of LDH. Construct the “Drugs-Compounds-Targets” network and search for the core targets. Use Gene Ontology functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and molecular docking verification to explore the possible molecular mechanism. Eighty-two effective compounds and 666 targets of BYHWD, 187 targets for LDH treatment, and 20 core candidate targets were excavated. A total of 3414 entries were identified by Gene Ontology enrichment analysis, 173 related signal pathways were identified by Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and 5 core compounds were identified by molecular docking, which had a good affinity with core genes STAT3, JUN, AKT1, MAPK1, RELA, and PIK3CA. BYHWD may play the role of analgesic and improving function by synergistic anti-inflammatory and analgesic compounds, regulating cell metabolic differentiation, regulating immunity, and anticoagulation. BYHWD in the treatment of LDH may play a role in analgesia and improve function through multiple signaling pathways, including PI3K-Akt, mitogen-activated protein kinase, tumor necrosis factor, and interleukin-17. The PI3K-Akt signaling may be one of the key mechanisms.
Expression and distribution pattern of aggrecanases and miR-140s in the thickened synovia of shoulder joints in rotator cuff tears: A retrospective observational study
Authors: Iino Takahiro , Tsujii Masaya , Wakabayashi Toru , Setoguchi Yoshimasa , Hasegawa Masahiro , Sudo Akihiro
Published: August 2022

The rotator cuff (RC) is frequently torn at the enthesis composed of fibrocartilage. We aimed to histopathologically evaluate lining layers and assess the distribution of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)4, ADAMTS5, and microRNA (miR)-140s in the synovia of patients with RC tears. We recruited 51 patients who underwent arthroscopic surgical treatment for full-thickness rotator cuff tears, including 26 patients with < 3 cm tear size (group N) and 25 patients with ≥ 3 cm tear size (group W). Biopsied synovia were analyzed using histological and immunohistological techniques for the presence ADAMTS4 and ADAMTS5. The layers of the synovial lining were morphologically classified into 3 grades according to the synovitis score and staining levels of ADAMTSs. The glenohumeral synovia from 8 patients with recurrent shoulder dislocation (group C) were used as controls. Furthermore, in situ hybridization was performed to evaluate the presence of miR-140s in patients with massive tears and recurrent shoulder dislocation. The staining levels were evaluated and analyzed based on comparison between patient groups and correlation between ADAMTS5 and miR-140s. Histological analysis revealed significant differences between groups W and C. ADAMTS5 and ADAMTS4 were strongly expressed in the synovial lining of patients in group W, and this expression was significantly higher than that in groups C and N. In addition, expression of ADAMTS5 was inversely correlated with that of miR-140-3p. This study showed that synovia from group W had a significantly higher rate of severely thickened areas with strong expression of both aggrecanases. Furthermore, the area with weak expression of miR-140-3p showed strong ADAMTS5 expression.
Evaluation of tongue mobility following release operation of ankyloglossia with genioglossus myotomy
Authors: Choi Ji Seon , Park Ji Hwan , Kim Min Cheol , Lim Jin Soo , Shim Hyung-Sup
Published: August 2022

Ankyloglossia is a congenital anomaly characterized by a short lingual frenulum and severe form needs release surgery. Our goal in this study was to confirm the long-term safety and efficacy of Z-plasty with genioglossus myotomy compared with traditional Z-plasty alone and to develop a proper measurement tool to validate the postoperative results of release operations for ankyloglossia. Patients were divided in 2 groups, release with Z-plasty only group (group 1) and Z-plasty combined with genioglossus myotomy group (group 2) In group 2, the release of central longitudinal fiber of genioglossus muscle was added in the conventional Z-plasty operative procedure. To analyze the results of the surgery, we developed an objective assessment tool which is the direct length from the innermost point of the floor of mouth to the tip of the tongue, preoperatively and postoperatively, which is called “functional tongue length.” A total of 101 patients with ankyloglossia ranging in age from 36 months to 8 years underwent release operation. Although there was no significant difference in terms of postoperative measurements between groups in Kotlow class II, group 2 patients in Class III and IV showed greater postoperative functional tongue length. Also, there was no significant complication requiring secondary surgery. Our study demonstrated that adding genioglossus myotomy to a simple Z-plasty is a safe and effective method for improving the tongue mobility required to make lingual sounds, especially in moderate to severe form of ankyloglossia, along with suggestion of a new measurement tool, which can objectively assess tongue mobility with possibility for universal utilization in ankyloglossia release operation.
How to report parameters and procedures for shockwave therapy in musculoskeletal disorders: A narrative review
Authors: de Menezes Athilas Braga , Back Cláudio Gregório Nuerberg , Driusso Patricia , Liebano Richard Eloin
Published: August 2022

Shockwave therapy (SWT) has been successful in the management of musculoskeletal conditions. The limitations of the use of SWT in clinical practice regard a lack of familiarity with the device and the lack of uniformity in information reported in scientific publications. Standardization in the reporting of these parameters could facilitate the reproduction and interpretation of data in future studies. Most studies fail to offer a detailed description of the parameters. Therefore, the aim of the present paper is to prepare a report on how to standardize the presentation of this information and serve a reference guide to report physical parameters and procedures of SWT when used on patients with musculoskeletal disorders. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. SWT parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, the description of patient and equipment positioning was added. The consensus-based guideline on how to report SWT parameters for the treatment of musculoskeletal conditions was developed to help clinicians and researchers.
T790M mutation positive squamous cell carcinoma transformation from EGFR-mutated lung adenocarcinoma after low dose erlotinib: A case report and literature review
Authors: Kusaba Yusaku , Takeda Yuichiro , Abe Sakurako , Tsukada Akinari , Naka Go
Published: August 2022

Rationale:

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used for the treatment of EGFR mutation positive advanced nonsmall cell lung cancer (NSCLC); however, acquired resistance is known to develop during these treatments. Among these mechanisms, histological transformation is seldom encountered. Although platinum based chemotherapy has been reported to be effective in the treatment of patients with small cell lung cancer transformation, there is a lack of information on the treatment of patients with squamous cell carcinoma (SQ) transformation.

Patient Concerns and Diagnosis:

An 80-year-old nonsmoking woman was referred to our hospital because of an abnormal shadow on her chest radiograph. Diagnostic bronchoscopy was performed and pathological examination revealed adenocarcinoma. Mutation analysis of the EGFR gene revealed deletion of E746-A750 in exon 19. She refused both surgical treatment and radiation therapy, and preferred periodic radiologic follow-up. Unfortunately, approximately a year and a half after the initial diagnosis, the primary lesion enlarged, and many pleural nodules were newly detected (clinically T4N2M1a, stage IVA).

Interventions and Outcomes:

Based on EGFR mutation analysis, a reduced dose of daily erlotinib was prescribed, which achieved a partial response and 34 months of progression-free survival (PFS). A repeated biopsy with an endobronchial cryoprobe was performed on the enlarged primary lesion. Pathological examination revealed SQ harboring an identical EGFR mutation with a secondary EGFR T790M mutation. Osimertinib 80 mg once a day was started as second line therapy, which resulted in 8 months of PFS and 15 months of survival.

Lesson:

The literature review and our report suggest that osimertinib is a promising treatment for NSCLC regardless of histology if T790M is present as an acquired mutation.
Plasma exchange therapy for familial chylomicronemia syndrome in infant: A case report
Authors: Han Lei , Qiang Guangfeng , Yang Lei , Kou Rui , Li Qiubo , Xin Meiyun , Liu Ruihan , Zhang Zhengjun
Published: August 2022

Introduction:

Familial chylomicronemia syndrome (FCS) is a rare genetic disease. FCS usually manifests by the age of 10 years, and 25% of cases of FCS occur during infancy. Here we present a case of FCS in a male infant and summarize our experiences on the diagnosis and therapy of this case.

Patient concerns:

A male infant aged 1 month and 8 days had recurrent hematochezia and hyperchylomicronemia.

Diagnosis:

FCS based on symptoms and genetic test.

Interventions:

Plasma exchange therapy.

Outcomes:

His development was normal with a good spirit and satisfactory weight gain, and no hematochezia occurred again.

Conclusion:

Genetic test is important for accurate diagnosis of FCS, and we identified a new mutation of lipoprotein lipase gene c.88C>A which conformed to autosomal recessive inheritance. Plasma exchange therapy can be applied to infants with FCS with low risk and good outcomes.
Effectiveness of Montessori-based activities on agitation among Asian patients with dementia: A systematic review and meta-analysis
Authors: Xu Lingyan , Zhang Zhihua , Xu Xiaoxun
Published: August 2022

Objectives:

Montessori based activity are supposed to be an effective nonpharmacological intervention in the treatment of agitation in western countries. However, most studies conducted to evaluate the effectiveness of Montessori based activities on agitation in Asian patients were small sample size, as well as inconsistent outcomes, which may limit the reliability of the conclusions. The present pooled analysis, hence, was conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.

Design:

Prospective randomized clinical studies were included, of which available data was extracted. Outcomes of physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors were pooled for the analysis by weighted mean differences.

Data sources:

Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang, and China Science and Technology Journal Database (VIP)

Eligibility criteria:

Prospective, randomized, controlled clinical studies, conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.

Data extraction and synthesis:

Available data including baseline characteristics and interested outcomes from the included literature were extracted independently by 2 investigators. Measuring scales including CMAI and NOSIE were adopted for the efficacy comparison between Montessori based activity and standard activity. Weighted mean difference was used for the pooled analysis.

Results:

A total of 460 participants were included in the present meta-analysis. The pooled mean difference agitation for Montessori based activity was –3.86 (95% CI: –7.38 to –0.34, P = 0.03) comparing to standard activity. The pooled mean differences for physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors in Montessori based activity group were –0.82 (95% CI: –1.10 to –0.55; P < 0.00001), –0.81 (95% CI: –1.68 to 0.55; P = 0.07), and 0.38 (95% CI: –0.92 to 1.68; P = 0.57).

Conclusions:

Montessori based activities may reduce the frequency of agitation, especially in physical aggressive behaviors comparing to standard activities in Asian patients with dementia. However, the effectiveness of Montessori based activities on reduction of subcategorized agitated behaviors including physical nonaggressive behaviors, and verbal aggressive behaviors may not be reliable as physical aggressive behaviors.
Differences in clinical characteristics among 726 patients with Chinese herbal medicine- or Western medicine-induced liver injury
Authors: Tan Kangan , Yang Wanna , Pang Lili , Hou Fengqin
Published: August 2022

The differences between Chinese herbal medicine (CHM)- and Western medicine (WM)-induced liver injury have rarely been reported. Our aim was to investigate the clinical features of patients with drug-induced liver injury (DILI) caused by CHM or WM.

The medical records of 726 DILI patients were retrospectively collected at Peking University First Hospital from January 1995 through August 2019.

The number of inpatients with DILI in our hospital showed an increasing trend over time. The incidence of DILI caused by CHM exhibited a linear trend toward an increase with time (P = .0012). Of the 726 DILI patients, females accounted for 65.8%. There were 353 cases (48.6%) caused by CHM and 225 cases (40.0%) caused by WM. The 3 most common causative CHMs were Polygonum multiflorum (38 cases), Fructus Psoraleae (35 cases), and Epimedium (26 cases). The proportions of female patients, alanine aminotransferase (ALT) levels, aspartate aminotransferase (AST) levels, total bilirubin (TBIL) levels and antinuclear antibody (ANA) positivity rates among cases caused by CHM were higher than those of cases caused by WM (P < .05). There were more patients with severe cases caused by CHM than with severe cases caused by WM (P < .05).

The clinical characteristics of DILI caused by CHM differ from those caused by WM. The incidence of DILI caused by CHM is increasing yearly. The medication time of DILI caused by CHM is longer than that of DILI caused by WM, and the severity is greater. Therefore, it is necessary to scientifically and rationally use traditional CHM and monitor liver function. For DILI caused by CHM, the CHM prescription should be recorded in detail to provide detailed clinical data for scientific research on the liver toxicity of CHM.
Manipulation of a clubfoot prior to a Ponseti method decreases the need for tenotomy!
Authors: Ralahy Fanjalalaina Malinirina , Andriamasinilaina Josué Lili , Stannage Katherine , Gray Jessie Lucey , Solofomalala Duval Gaëtan
Published: August 2022

The combination of the Ponseti method with functional treatment produces better results and may reduce the need for surgery. The objective of this study was to assess the impact of manipulation of a congenital equinovarus clubfoot performed before correction by the Ponseti method.

This was a cohort study of children <5 years treated with the Ponseti method followed over a minimum period of 1 year. Each foot was treated according to the Ponseti method. The study parameters were as follows: age, gender, concept of previous treatment, previous treatment with manipulation, the degree of deformation according to the Pirani score, the laterality of the deformation, the number of casts required and the time needed for correction, the evolution of the Pirani score before each correction by plaster, the use or not of tenotomy and the Pirani score at the end of the correction session, the evolution of the Pirani score when wearing an abduction boot.

The series comprised a total of 68 feet. The average age of the children was 15.5 months. Regarding the deformity, 29 children presented a severe or very severe deformity. Before the treatment, 16 children received regular handling massage. Feet that had received manipulation prior to correction were the least exposed to tenotomy (P = .009). For the children who did not require a tenotomy, all the feet had a Pirani score of zero after the fourth week of wearing the splint. We noted a rapidly decreasing in the Pirani score of the feet, which did not require an tenotomy compared with other feet (Kolmogorov-Smirnov test: D = 0.61; P = .01).

The combination of functional treatment with the Ponseti method reduces the need for tenotomy.
Effect of sedation using Ketamine for primary closure of pediatric facial laceration
Authors: Lee Ju Ho , Woo Sang Seok , Shin Se Ho , Kim Hyeon Jo , Kim Jae Hyun , Kim Seong Hwan , Suh In Suck
Published: August 2022

Pediatric lacerations are frequently encountered by plastic surgeons in the emergency room. Since pediatric patients cannot cooperate due to the anxiety and pain occurring during the suture procedure, sedation is induced. Since commonly used drugs inducing shallow sedation such as chloral hydrates are insufficient to perform procedures, the need or deep sedation has been increased. In our experience, inducing sedation with ketamine is safe and allows for accurate procedures.

A total of 106 pediatric patients aged between 3 months to 5 years who visited the emergency room between August 2020 and January 2021 were included in this study. Of the 106 patients, 54 were sedated using ketamine, and the remaining 52 patients who did not cooperate were operated under local anesthesia, and these were set as the control group. The patients were intravenously injected with ketamine 1.5–2.0 mg/kg ketamine while monitoring the blood oxygen saturation, end-tidal CO2, and other vital signs. The patients were discharged as a complete awakening was confirmed by physicians.

The number of patients who received sedation induced by ketamine was 54 and the number of patients who underwent the procedure without sedation was 52. The mean induction time of a single injection was 35.3 ± 11.3 minutes, and that of additional injection was 253.5 ± 54.1 minute. The total procedure time of the ketamine group was 20.3 ± 11.85 minutes, and that of the nonketamine group was 19.31 ± 10.50 minutes (P = .454). No statistically significant differences were found between the 2 groups.

The need for sedation during the suture procedure in an emergenc9y room has been arising not only for reducing pain and anxiety, but also for safe and accurate procedures and scar minimization.

Based on the parental satisfaction and the safety of the procedure, using ketamine is more effective than other drugs and should be used more actively.
The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome
Authors: Wang Tie-Yan , Zhu Ying , Yin Jia-Lin , Zhao Li-Yan , Wang Hai-Jun , Xiao Chun-Wang , Wu Li-Yan
Published: August 2022

Objective:

To investigate the efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS).

Methods:

This study is a retrospective clinical study. Seventy-two NRDS neonates were selected as the subjects from November 2019 to November 2020, and divided into observation group (40 cases, HFOV treatment) and control group (32 cases, conventional mechanical ventilation treatment). All cases were treated with PS and comprehensive treatment. The therapeutic effect, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), Percentage of inhaled oxygen concentration (FiO2), mean arterialpressure, oxygenation index (OI), and complications were compared in the 2 groups.

Results:

The total effective rate of the observation group was 90.0%, significantly higher than that of the control group. After treatment, the observation group has higher PaO2 levels and lower levels of PaCO2, mean arterial pressure, FiO2, and OI than the control group. There was no significant difference in the incidence of complications between the 2 groups.

Conclusion:

HFOV combined with PS has a significant effect on NRDS, which can improve the arterial blood gas index without increasing the incidence of complications.
Evaluation of age-related thymic changes using computed tomography images: A retrospective observational study
Authors: Suzuki Kosuke , Kitami Akihiko , Okada Momoka , Takamiya Shinnosuke , Ohashi Shinichi , Tanaka Yoko , Uematsu Syugo , Kadokura Mitsutaka , Suzuki Takashi , Hashizume Norihiro , Fujisawa Hidefumi
Published: August 2022

We aimed to investigate if Computed tomography (CT) attenuation values can help improve the identification of age-related changes in the thymus.

We assessed CT images of 405 patients aged 0 to 80 years. We measured the area of the anterior mediastinum at the level of the carina and its average CT attenuation value. We evaluated the thymic area, the ratio of the thymus area to the total thoracic area, and the CT attenuation value. Additionally, we evaluated changes in the thymus area in the 0 to 13-year age group.

The area of the thymus decreased from birth to the middle 20s. After the middle 20s, the area tended to increase and plateau till after 50 years of age. The ratio of the thymic area to the thoracic area decreased from age 0 to 20 years, but remained stable after 20 years of age. The CT attenuation values were stable from birth to puberty, decreased after puberty, and were stable again in the late 50s and beyond. The thymus of children showed mass formation, but the shape changed with age. No significant differences in the CT attenuation value were found across underlying conditions for the 0 to 13-year age group.

The decrease in the CT attenuation values, observed with advancing age, reflects adipose degeneration of the thymus, indicating that by the late 50s, thymic tissue is replaced completely by adipose tissue. Our data suggest that adipose degeneration of the thymus begins after puberty and advances with age.
The efficacy of combined therapy of qingfeiPaidu capsule and lianhuaqingwen capsule nursing interventions for hospitalized patients with COVID-19: A retrospective study of medical records
Authors: Li Yan , Yu Wenhan , Zhai Jinxia , Wang Kun , Huo Hongdan , Du Zonghua
Published: August 2022

Coronavirus disease-19 (COVID-19) caused a global pandemic burden, affecting hundreds of thousands of individuals, having life-threatening outcomes. Traditional Chinese Medicine plays a crucial role in the treatment of patients with COVID-19. The purpose of this study was to investigate the efficacy of combined therapy of qingfeiPaidu (QFPD) capsule and lianhuaqingwen (LHQW) capsule nursing interventions in the treatment of patients with COVID-19. A total of 318 patients with COVID-19 were enrolled and randomly received QFPD (n = 106), LHQW (n = 106), and QFPD-LHQW (n = 106). The clinical characteristics of COVID-19, the total lung severity scores, and blood laboratory indices were recorded in each patient in each group before treatment and at the end of treatment.

The outcomes demonstrated that QFPD-LHQW group shortened the length of hospitalization, decreased C-reactive protein, creatine kinase, creatine kinase-myocardial band, lactate dehydrogenase, and blood urea nitrogen levels, and improved clinical symptoms, pulmonary inflammation, and prognosis. At the end of treatment, inflammation, immune function, circulating white blood cells, total lymphocyte count, and glutamic-oxaloacetic transaminase levels improved dramatically in 3 groups compared with baseline. All patients met the discharge criteria after 30-day treatment in 3 groups. Combined therapy of QFPD and LHQW demonstrated significant anti-inflammatory effects compared with those of only QFPD or LHQW in patients with mild and moderate COVID-19. The combined therapies may alleviate clinical symptoms of COVID-19 patients by improving inflammation and immune function.
Novel homozygous nonsense mutation associated with Bardet–Biedl syndrome in fetuses with congenital renal malformation
Authors: Cai Meiying , Lin Min , Lin Na , Xu Liangpu , Huang Hailong
Published: August 2022

Background:

The Bardet–Biedl syndrome (BBS) is a rare autosomal recessive disorder, characterized by clinical and genetic heterogeneity. BBS is more commonly reported in adults and children than in fetuses. Here, a retrospective study on 210 fetuses with congenital renal malformation was conducted.

Methods:

The fetuses were diagnosed using invasive prenatal tests, including chromosome karyotype analysis, whole exome sequencing (WES), and single-nucleotide polymorphism array. We found the intrauterine phenotype of a fetus presenting enlarged kidneys, enhanced echo, and oligohydramnios; therefore, the fetus was characterized to have BBS.

Results:

Chromosome karyotype analysis presented normal results. Analysis using an Affymetrix CytoScan 750K array revealed 2 homozygous regions. However, WES revealed a homozygous mutation of c.1177C>T (p.Arg393*) on exon 12 of BBS1 and a heterozygous variation of c.2704G>A (p.Asp902Asn) on exon 22 of CC2D2A. The American College of Medical Genetics and Genomics guidelines identified c.1177C>T and c.2704G>A as a pathogenic mutation and of uncertain significance, respectively. Sanger sequencing identified heterozygous mutation, that is, c.1177C>T and heterozygous variation, that is, c.2704G>A in the parents of the fetus.

Conclusions:

WES identified a novel homozygous nonsense mutation c.1177C>T in BBS1 of a Chinese fetus with congenital renal malformation. This finding provides insight into the BBS1 mutations in Asian populations in general and shows the necessity of genetic counseling.
Effects of antioxidant intervention in patients with polycystic ovarian syndrome: A systematic review and meta-analysis
Authors: Zhao Junde , Sui Xiaohui , Shi Qingyu , Su Dan , Lin Zhiheng
Published: August 2022

Background:

The role of antioxidant intervention in polycystic ovary syndrome (PCOS) patients has been increasingly investigated in recent years. In order to further clarify whether antioxidant therapy is beneficial for PCOS patients and the emphasis of its effects, this study provides a systematic review and meta-analysis of randomized controlled trials examining the effect of antioxidant intervention on PCOS.

Methods:

Enrolled study designs related to antioxidant interventions and PCOS, published from 1999 to 2020, were searched from EMBASE, PubMed, and Web of Science databases to sort out proven studies on antioxidant interventions and PCOS. Data were reported as weighted mean difference (WMD) or standard mean difference with associated confidence intervals of 95%. The analysis was conducted using Stata version 16.0.

Results:

Twenty-three studies were included in total. Antioxidant intervention had a positive impact on homeostasis model assessment of insulin resistance (WMD = –0.37, P = .011) and Triglycerides (WMD = –25.51, P < .001). And antioxidant intervention did not improve testosterone levels significantly (WMD = –0.20, P = .2611). Subgroup analysis showed that except for the D-chiro-inosito subgroup, no difference in body mass index was observed between the intervention group and the control group.

Conclusions:

This meta-analysis demonstrates the efficacy of antioxidant intervention in patients with PCOS, demonstrating that antioxidant intervention has a significant effect on insulin resistance and lipid metabolism improvement. However, antioxidant intervention therapy has no discernible impact on testosterone levels or body mass index. Omega-3 may be a more effective antioxidant intervention for PCOS. In addition, this meta-analysis provides important reference opinions and treatment recommendations for PCOS.