bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardized Patients’ Perspectives on Bias in Student Encounters
Authors: Fluet Angelina , Essakow Jenna , Ju Mindy
Published: August 2022

Purpose

Standardized patient (SP) encounters are widely used in health professional education to evaluate trainees’ clinical skills. Prior literature suggests that bias can influence the evaluations of student learners in SP–student encounters. Understanding how SPs perceive bias in their work and how they view their role in mitigating or perpetuating bias in simulation is an important first step in addressing bias in the SP–student encounter.

Method

Researchers designed a qualitative interview study and conducted 16 semistructured interviews with SPs at the University of California, San Francisco Kanbar Simulation Center from July through September of 2020. Participants were selected using purposive sampling. The interviews were transcribed and analyzed by researchers using inductive thematic analysis. Researchers met iteratively to reconcile codes and identify themes.

Results

SPs identified bias occurring in multiple directions: SP-to-student, student-to-SP, student-to-character, and SP-to-character. SPs were hesitant to label their own biases and instead used words such as “comfort” or “preference.” SPs reported little bias from students, because students were being evaluated and therefore behaving carefully. Additionally, SPs perceived bias in the implementation of health care simulation, which manifests as underrepresentation of certain groups amongst actors and character descriptions. Most SPs felt that they should play a role in mitigating bias in SP–student encounters, including addressing bias that occurs, challenging stereotypes, teaching about cultural differences, and/or being conscious of bias in their assessments of learners.

Conclusions

In the SP–student encounter, bias can occur on many levels and between many individuals, including between the SP and the character they are portraying. Identifying the areas in which bias can exist can help simulation educators mitigate bias.
Is pancreatic giant cell tumor resistant to standard chemotherapy?
Authors: Çağlayan Dilek , Karakurt Eryilmaz Melek , Korkmaz Mustafa , Karaağaç Mustafa , Hendem Engin , Artaç Mehmet
Published: August 2022

Pancreatic giant cell tumors (PGCTs), undifferentiated pancreatic carcinoma are rare tumors of the pancreas. PGCTs consist of osteoclastic, pleomorphic and mixed variants. PGCT is usually diagnosed at an advanced stage. PGCT has a worse prognosis than pancreatic ductal adenocarcinoma. Although surgery can be curative, there is no standard treatment approach for advanced PGCT. We present a case of PGCT that is resistant to standard therapy and progresses in a short time.
Ibrutinib and panitumumab used in combination safely in a patient with metachronous colorectal cancer and chronic lymphocytic leukemia
Authors: Korkmaz Mustafa , Karakurt Eryilmaz Melek , Karaağaç Mustafa , Araz Murat , Çeneli Özcan , Artaç Mehmet
Published: August 2022

Ibrutinib is a Bruton tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL). Panitumumab, an mAb for epidermal growth factor receptor, is used in the treatment of metastatic colorectal cancer (CRC). We wanted to present our case where we used ibrutinib and panitumumab in combination in a patient with metachronous CLL and CRC. A 58-year-old male patient with a diagnosis of CLL was receiving ibrutinib treatment and primary rectal cancer was detected. FOLFOX + panitumumab were started when metastasis was detected in the lung after neoadjuvant chemoradiotherapy for rectal cancer. The patients used ibrutinib and panitumumab in combination. There was no cumulative or unexpected toxicity due to the combination of both antineoplastic agents. The most important point to be considered in the use of combined drugs is the evaluation of drug–drug interactions. Toxic effects of the combination of ibrutinib and cetuximab have been reported in a patient with metastatic CRC. We used ibrutinib together with panitumumab in our case and we did not encounter any cumulative or unexpected side effects during the treatment.
Purvalanol A induces apoptosis and reverses cisplatin resistance in ovarian cancer
Authors: Zhang Xiaoyi , Hong Shasha , Yang Jiang , Liu Jingchun , Wang Ying , Peng Jiaxin , Wang Haoyu , Hong Li
Published: August 2022

Cisplatin (DDP) resistance limits therapeutic efficacy in patients diagnosed with ovarian cancer. Purvalanol A (Pur) is a novel cyclin-dependent kinase (CDK) inhibitor that has been demonstrated to induce apoptosis in various cancer cells. The present study investigated the effect of the combination treatment of Pur and DDP, and the potential anticancer mechanisms in epithelial ovarian cancer (EOC) cells in vitro and in vivo. We found that Pur enhanced the anti-tumor efficacy of cisplatin in EOC cells. The combination of Pur and DDP had more significant effects on apoptosis induction in EOC cells compared with the individual-treatment groups and the control group. We further demonstrated that the combination of Pur and DDP may trigger apoptosis and autophagy in EOC cells by inducing reactive oxygen species (ROS). And the ROS/Akt/mammalian target of rapamycin signaling pathway as a potential mechanism for the initiation of autophagy induced by combination therapy. Similar results were observed in vivo. These results demonstrated that Pur sensitized the response of EOC cells to cisplatin in vitro and in vivo, reversing the resistance to cisplatin in ovarian cancer.
American Radium Society (ARS) Appropriate Use Criteria (AUC) for Locoregional Gastric Adenocarcinoma
Authors: Kumar Rachit , Tchelebi Leila , Anker Christopher J. , Sharma Navesh , Bianchi Nancy A. , Dragovic Jadranka , Goodman Karyn A. , Herman Joseph M. , Jiang Yixing , Jones William E. , Kennedy Timothy J. , Lee Percy , Kundranda Madappa , Russo Suzanne , Small William , Suh Wonsuk W. , Yee Nelson , Jabbour Salma K.
Published: August 2022

Objective:

The objective of this study was to systematically evaluate the data regarding the use of neoadjuvant, perioperative, surgical, and adjuvant treatment options in localized gastric cancer patients and to develop Appropriate Use Criteria recommended by a panel of experts convened by the American Radium Society.

Methods:

Preferred reporting items for systematic reviews and meta-analyses methodology was used to develop an extensive analysis of peer-reviewed phase 2/2R/3 trials, as well as meta-analyses found within the Ovid Medline database between 2010 and 2020. The expert panel then rated the appropriateness of various treatments in 5 representative clinical scenarios through a well-established consensus methodology (modified Delphi).

Results:

For patients with medically operable locally advanced gastric cancer, the strongest recommendation was for perioperative chemotherapy based on high-quality data. Acceptable alternatives included surgery followed by either chemotherapy or concurrent chemoradiotherapy (CRT). For patients with upfront resection of stages I to III gastric cancer (no neoadjuvant therapy), the group strongly recommended adjuvant therapy with either chemotherapy alone or CRT, based on high-quality data. For patients with locally advanced disease who received preoperative chemotherapy without tumor regression, the group strongly recommended postoperative chemotherapy or postoperative CRT. Finally, for medically inoperable gastric cancer patients, there was moderate consensus recommending definitive concurrent CRT.

Conclusions:

The addition of chemotherapy and/or radiation, either in the neoadjuvant, adjuvant, or perioperative setting, results in improved survival rates for patients compared with surgery alone. For inoperable patients, definitive CRT is a reasonable treatment option, though largely palliative.
Relationships Among Parenting Stress and Well-Being, COVID-19 Information Management, and Children's COVID-19 Fear
Authors: Boone Dianna M. , Stromberg Sarah , Fritz Alyssa , Rodriguez Juventino Hernandez , Gregus Samantha , Faith Melissa A.
Published: August 2022

Objective:

During the COVID-19 pandemic, caregivers who are facing high stress levels and decreased emotional well-being may parent their children differently. Certain children are experiencing greater fear in response to COVID-19, and research is needed to identify parenting behaviors significantly linked with children's COVID-19 fear. The purpose of this article was to evaluate whether the association between parenting stress and children's COVID-19 fear could be explained by parents' COVID-19 information management and emotional well-being.

Methods:

Participants were recruited through Amazon Mechanical Turk. The sample consisted of 595 caregivers of children during the COVID-19 pandemic; 40.0% men, 69.2% non-Latinx White, 12.1% Black, 10.1% Latinx, 6.6% Asian, and <2% others. Children had an average age of 11.3 years. Parents completed self-report measures.

Results:

The bootstrapped confidence interval (0.040, 0.148) for the indirect effect (0.090) revealed that parent emotional well-being significantly mediated the relation between parenting stress and children's COVID-19 fear. In addition, parent management of children's COVID-19 knowledge significantly mediated the relation between parenting stress and children's COVID-19 fear.

Conclusion:

We found that the combined effect of parents' emotional well-being and parents' management of children's COVID-19 knowledge significantly mediated the positive relation between parenting stress and children's COVID-19 fear. Based on our findings, once parents' parenting stress is decreased and their well-being increases, parents may be more likely to provide children with developmentally appropriate and accurate COVID-19 information.
No benefit of hydrocortisone, ascorbic acid, and thiamine in reducing mortality in adult sepsis patients: a systematic review and meta-analysis
Authors: Zhao Qing , Xiao Jianguo , Liu Hui
Published: August 2022

Background

Supplementation of corticosteroid, ascorbic acid and thiamine in adult septic patients remains controversial. We aimed to evaluate the efficacy and safety of hydrocortisone, ascorbic acid and thiamine (HAT) in adult septic patients.

Methods

Data search included Pumbed, EMBASE, and the Cochrane Library from inception to Sep, 2021. Only studies with classifications of sepsis and intravenous HAT treatment were included. Adult patients with sepsis (aged ≥18 years) were divided into 2 groups. The treatment group received HAT therapy, whereas the control group received standard care and/or intravenous hydrocortisone. The primary outcome was hospital mortality.

Results

Eleven studies including 4579 patients who fulfilled the predefined criteria were analyzed (6 randomized controlled trials [RCTs] and 5 clinical cohort studies). No hospital mortality reduction was demonstrated in patients treated with HAT when compared to the reference (OR: 0.99; 95% CI: 0.77 to 1.27; I
2 = 39%) group. Sequential organ failure assessment (SOFA) score decrement at 72hours was more significant in HAT-treated patients (mean difference [MD]: –1.23; 95% CI: –1.94 to –0.53; I
2 = 81%). There was no difference in the duration of vasopressor use between HAT-treated patients and controls (MD: –4.92; 95% CI: –24.38 to 14.53; I
2 = 97%). Statistical heterogeneity was noted with no sign of significant publication bias.

Conclusion

In adult sepsis and septic shock patients, HAT treatment failed to reduce mortality or shorten vasopressor duration, but reduced SOFA scores.
Comparison of the anxiety level between the medical staff and the public during the early phase of the coronavirus disease 2019 pandemic
Authors: Luo Guanguan , Liu Yumin , Yao Dongai , Ni Shaozhou , Wu Bangsheng , Lin Liting , Wang Yunming , Jin Xiaoqing
Published: August 2022

Background

A sudden outbreak of the coronavirus disease 2019 (COVID-19) started in December 2019 in Wuhan, China. Up-to-date, there have been limited studies examining the anxiety status of Chinese individuals in the early phase of the pandemic period (January 30, 2020–February 15, 2020). This survey aimed to compare the level of anxiety of the medical staff with that of the public and to provide a theoretical basis for developing an effective psychological intervention.

Method

Questionnaires were sent on the Internet (http://www.wjx.cn) during this period. The anxiety levels of Chinese people were investigated using the Self-Rating Anxiety Scale (SAS), and the demographic data were collected simultaneously.

Results

A total of 1110 participants were enrolled in this study, with an effective response rate of 100%. A total of 482 respondents were medical staff (43.4%), while 628 were members of the general public (56.6%). The medical staff itself had a higher SAS score than the general public (48.36±13.40 vs. 45.74±11.79, P < 0.01), while the medical staff in Wuhan were more anxious than the public in Wuhan with a higher SAS score (54.17±14.08 vs. 48.53±11.92, P < 0.01).

Conclusion

The COVID-19 pandemic has had a significant impact on the anxiety levels of the medical staff and the public, with the medical personnel showing a higher anxiety level than the public, especially female medical staff in Wuhan. Therefore, urgent intervention programs to reduce anxiety should be implemented.
The discriminative stimulus effects of baclofen and gamma hydroxybutyrate in C57BL/6J mice
Authors: Wilkerson Jenny L. , Hiranita Takato , Koek Wouter , McMahon Lance R.
Published: August 2022

Baclofen and γ-hydroxybutyrate (GHB) exert γ-aminobutyric acid (GABA)B receptor agonism and have therapeutic utility but possess different pharmacological activities. We examined whether separate groups of mice could be trained to discriminate either baclofen or GHB, and the contribution of GABAB receptors to discriminative stimulus effects. Male C57BL/6J mice were trained to discriminate either baclofen (3.2 mg/kg, intraperitoneal) or GHB (178 mg/kg, intraperitoneal) from saline under a fixed-ratio 10 schedule. The GABAB antagonist 3-aminopropyl(diethoxymethyl)phosphinic acid (CGP 35348) was used to pharmacologically assess GABAB receptor involvement. The selectivity of the resulting discriminations was assessed with the opioid agonist morphine and the benzodiazepine midazolam. In baclofen-trained mice, both baclofen and GHB were readily discriminated. Baclofen produced a maximum of 86% baclofen-appropriate responding. CGP 35348 (320 mg/kg, i.p.) produced a 4.7-fold rightward shift in the dose-effect function. GHB produced a maximum of 85.8% baclofen-appropriate responding. In GHB-trained mice, both GHB and baclofen were readily discriminated. In GHB-trained mice, GHB produced a maximum of 85.3% drug-appropriate responding; CGP 35348 (320 mg/kg, i.p.) produced a 1.8-fold rightward shift in the GHB discrimination dose-effect function. Baclofen produced up to 70.0% GHB-appropriate responding. CGP 35348 (320 mg/kg, i.p.) significantly antagonized baclofen discrimination and baclofen produced up to 37% GHB-appropriate responding up to doses that disrupted operant responding. Morphine did not produce substitution for either baclofen or GHB. Midazolam produced partial substitution for both. GHB and baclofen discrimination assays in mice provide a useful approach for examining different receptor types mediating the effects of these two drugs.
Impact of cytochrome P450 2C19 polymorphisms on the clinical efficacy and safety of voriconazole: an update systematic review and meta-analysis
Authors: Zhang Ying , Hao Xu , Hou Kelu , Hu Lei , Shang Jingyuan , He Shiyu , Yang Changqing , Huang Lin , Feng Yufei
Published: August 2022

Objective

To assess the impact of cytochrome P450 (CYP) 2C19 polymorphisms on the clinical efficacy and safety of voriconazole.

Methods

We systematically searched PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and three Chinese databases from their inception to 18 March 2021 using a predefined search algorithm to identify relevant studies. Studies that reported voriconazole-treated patients and information on CYP2C19 polymorphisms were included. The efficacy outcome was success rate. The safety outcomes included overall adverse events, hepatotoxicity, and neurotoxicity.

Results

A total of 20 studies were included. Intermediate metabolizers (IMs) and poor metabolizers (PMs) were associated with increased success rates compared with normal metabolizers (NMs) [risk ratio (RR), 1.18; 95% confidence interval (CI), 1.03–1.34; I
2 = 0%; P = 0.02; RR, 1.28; 95% CI, 1.06–1.54; I
2 = 0%; P = 0.01]. PMs were at increased risk of overall adverse events in comparison with NMs and IMs (RR, 2.18; 95% CI, 1.35–3.53; I
2 = 0%; P = 0.001; RR, 1.80; 95% CI, 1.23–2.64; I
2 = 0%; P = 0.003). PMs demonstrated a trend towards an increased incidence of hepatotoxicity when compared with NMs (RR, 1.60; 95% CI, 0.94–2.74; I
2 = 27%; P = 0.08), although there was no statistically significant difference. In addition, there was no significant association between CYP2C19 polymorphisms and neurotoxicity.

Conclusion

IMs and PMs were at a significant higher success rate in comparison with NMs. PMs were significantly associated with an increased incidence of all adverse events compared with NMs and IMs. Researches are expected to further confirm these findings. Additionally, the relationship between hepatotoxicity and CYP2C19 polymorphisms deserves clinical attention.
Molecular Cytogenetic Profiling Reveals Similarities and Differences Between Localized Nodal and Systemic Follicular Lymphomas
Authors: Horn Heike , Jurinovic Vindi , Leich Ellen , Kalmbach Sabrina , Bausinger Julia , Staiger Annette M. , Kurz Katrin S. , Möller Peter , Bernd Heinz-Wolfram , Feller Alfred C. , Koch Karoline , Klapper Wolfram , Stein Harald , Hansmann Martin-Leo , Hartmann Sylvia , Scheubeck Gabriel , Dreyling Martin , Hiddemann Wolfgang , Herfarth Klaus , Engelhard Marianne , Rosenwald Andreas , Hoster Eva , Ott German ,   for the German Low-Grade Lymphoma Study Group (GLSG)
Published: August 2022

Recently, we have developed novel highly promising gene expression (GE) classifiers discriminating localized nodal (LFL) from systemic follicular lymphoma (SFL) with prognostic impact. However, few data are available in LFL especially concerning hotspot genetic alterations that are associated with the pathogenesis and prognosis of SFL. A total of 144 LFL and 527 SFL, enrolled in prospective clinical trials of the German Low Grade Lymphoma Study Group, were analyzed by fluorescence in situ hybridization to detect deletions in chromosomes 1p, 6q, and 17p as well as BCL2 translocations to determine their impact on clinical outcome of LFL patients. The frequency of chromosomal deletions in 1p and 17p was comparable between LFL and SFL, while 6q deletions and BCL2 translocations more frequently occurred in SFL. A higher proportion of 1p deletions was seen in BCL2-translocation–positive LFL, compared with BCL2-translocation–negative LFL. Deletions in chromosomes 1p, 6q, and 17p predicted clinical outcome of patients with SFL in the entire cohort, while only deletions in chromosome 1p retained its negative prognostic impact in R-CHOP–treated SFL. In contrast, no deletions in one of the investigated genetic loci predicted clinical outcome in LFL. Likewise, the presence or absence of BCL2 translocations had no prognostic impact in LFL. Despite representing a genetic portfolio closely resembling SFL, LFL showed some differences in deletion frequencies. BCL2 translocation and 6q deletion frequency differs between LFL and SFL and might contribute to distinct genetic profiles in LFL and SFL.
Use of Mechanical Circulatory Support to Demonstrate Pulmonary Hypertension Reversibility in Mitral Stenosis
Authors: Sparks Aaron T. , Kawabori Masashi , Chen Frederick Y. , Couper Gregory S.
Published: August 2022

A 56 year old female with a history of rheumatic mitral stenosis (MS) presented with severe pulmonary edema. Transthoracic echocardiogram demonstrated severe MS (mean valve area 0.5 cm2, mean gradient of 16 mm Hg) with preserved left ventricular ejection fraction. Right heart catheterization demonstrated elevated pulmonary artery (PA) pressures of 110/80 mm Hg and a wedge pressure of 40 mm Hg. Mechanical circulatory support (MCS) was initiated with extracorporeal left atrial to femoral artery bypass. MCS allowed preoperative unloading of the left atrium. The volume status and lung congestion were optimized before surgery. In addition, pulmonary hypertension reversibility was demonstrated with significantly lower PA pressures after initiation of MCS. Intraoperatively, the MCS left atrial inflow cannula was pulled back into the right heart and used as a venous cannula for cardiopulmonary bypass. Successful mitral valve replacement was performed. Postoperatively, the mitral valve mean gradient was 3 mm Hg.
Molecular heterogeneity of factor XI deficiency in Tunisia
Authors: Gharbi Maroua , Elmahmoudi Hejer , ElBorgi Wejden , Ouardani Cherifa , Achour Meriem , Gouider Emna
Published: August 2022

Factor XI (FXI) deficiency is a rare inherited bleeding disorder that is highly prevalent in Ashkenazi Jewish ancestry but sporadically observed in most ethnic groups. It is heterogeneous both in clinical presentation and in genetic causality. Although a large spectrum of mutations associated with this disorder has been reported in several populations, genetic data of FXI deficiency in Tunisia are poorly described. The purpose of this study was to determine the molecular basis of FXI deficiency among Tunisian patients. Fourteen index cases from nine unrelated families with FXI deficiency, referred to Hemophilia Treatment Center of Aziza Othmana Hospital, were included in this study. The patients’ F11 genes were amplified by PCR and subjected to direct DNA sequencing analysis. Sequencing analysis of F11 genes identified three distinct mutations; the Jewish type II nonsense mutation E117X, one previously reported missense mutation E602Q and one novel missense mutation V271M, which led to the disruption of the third apple domain structure of FXI. Furthermore, seven polymorphisms previously described, were also detected: C321F, c. 294A>G, -138 A>C, p.D125D, p.T249T, p.G379G, p.D551D. This report represents the first genetic study analyzing the molecular characteristics of factor XI deficiency within Tunisian population. Identification of the Jewish type II mutation in two families, as well as one missense previously reported mutation and one novel mutation confirmed the genetic heterogeneity of this disorder. Screening a large number of Tunisian factor XI deficient would reveal the spectrum mutations causing factor XI deficiency in Tunisia.
Meditation-based intervention for obsessive-compulsive disorder: A PRISMA-compliant systematic review and meta-analysis
Authors: Lee Si Myeong , Suh Hyo-Weon , Kwak Hui-Yong , Kim Jong Woo , Chung Sun-Yong
Published: August 2022

Background:

The purpose of this study was to investigate the effects of the meditation-based intervention on obsessive-compulsive disorder (OCD).

Methods:

The following databases were searched up to April 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline (via PubMed), PsycARTICLES, 4 Korean databases (Korean Medical Database [KMbase], Koreanstudies Information Service System [KISS], National Digital Science Library [NDSL], and Oriental Medicine Advanced Searching Integrated System [OASIS]), and China National Knowledge Infrastructure (CNKI). The search terms related to meditation-based intervention and OCD were used. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The selected articles were evaluated using the Cochrane risk of bias tool. The Review Manager (RevMan) 5.4 was used to perform the meta-analysis.

Results:

In all, 16 randomized controlled trials were selected. The meta-analysis showed that the group receiving the treatment combining medication and meditation-based intervention for OCD showed a more significant post-treatment improvement in Yale-Brown obsessive compulsive scale than the group receiving medication only. Compared with other non-medication interventions that are known to be effective in treating OCD, the Yale-Brown obsessive compulsive scale showed a significant improvement immediately after the meditation-based intervention. However, no significant difference was found in the follow-up monitoring data across all examined cases.

Conclusion:

This study was conducted to verify the effects of meditation-based intervention on OCD. The results suggested that combined treatment with medication and meditation-based intervention was more effective in treating OCD than medication alone; the positive effects of meditation-based intervention may be greater than the effects of other non-medication interventions. However, the lack of significant difference in the follow-up indicates that long-term effect of meditation-based interventions is unclear.

Trial registration number:

PROSPERO CRD42021244408
Lymph node metastasis as the initial symptom of a germ cell tumor in an adult: A case report
Authors: Guo Fang , Wang Hongbing , Xia Heshun , Shi Hongwei , Xu Peng , Pi Guoliang
Published: August 2022

Rationale:

Germ cell tumors in the head and neck are very rare. In cases of germ cell tumors, it is uncommon for lymph node metastasis to be the only and initial symptom, and this can easily lead to a misdiagnosis. Herein, we report about a 28-year-old woman with lymph node metastasis, in whom a primary tumor appeared in the nasal cavity.

Patient concerns:

A 28-year-old woman presented with enlarged left submandibular lymph nodes. No other mass was found on whole-body screening using positron emission tomography-computed tomography.

Diagnosis:

After partial submandibular lymphadenectomy was performed, histopathological and immunohistochemical examinations revealed a metastatic germ cell tumor. However, it was difficult to further classify and affirm the origin.

Interventions:

As the patient was receiving four cycles of bleomycin, etoposide, and cisplatin chemotherapy, a primary tumor emerged in the nasal cavity, which was finally confirmed as an immature teratoma of a high World Health Organization histological grade and Norris grade 3. This tumor was found to contain similar components to lymph nodes with respect to histopathological and immunohistochemical characteristics, especially the immature neural tubes or nervous tissue in the nasal cavity. Fortunately, the patient recovered well with no signs of relapse, and the size of residual lymph nodes remained unchanged after she received another four cycles of bleomycin, etoposide, and cisplatin chemotherapy and two cycles of doxorubicin and ifosfamide (AI) chemotherapy.

Outcomes:

Unfortunately, 11 months later, during the coronavirus disease pandemic, the patient died owing to respiratory failure and pulmonary infection.

Conclusions:

In cases of malignant tumor in the submandibular lymph nodes of adults, the metastasis of a germ cell tumor should be considered an important differential diagnosis even if a primary tumor does not emerge. In this case, adequate postoperative chemotherapy is necessary.
Numerical simulation and biomechanical analysis of locking screw caps on clavicle locking plates
Authors: Kim Dae-Geun , Min Kim Soo , Kim Yoonkap
Published: August 2022

Background:

The risk of displaced and comminuted midshaft clavicle fractures is increased in high-energy traumas such as sport injuries and traffic accidents. Open reduction and plate fixation have been widely used for midshaft clavicle fractures. Among various plates for clavicle shaft fractures, superior locking compression plates (LCPs) have been mostly used. In plate fixation, nonunion caused by implant failure is the most difficult complication. The most common reasons for metal plate failure are excessive stress and stress concentration caused by cantilever bending. These causes were easily addressed using a locking screw cap (LSC).

Methods:

The clavicle 3-dimensional image was made from a computed tomography scan, and the clavicle midshaft fracture model was generated with a 10-mm interval. The fracture model was fixed with a superior LCP, and finite element analysis was conducted between the presence (with LSC model) and absence (without LSC model) of an LSC on the site of the fracture. The stresses of screw holes in models with and without LSCs were measured under 3 forces: 100 N cantilever bending force, 100 N axial compression force, and 1 N·m axial torsion force. After the finite element analysis, a validation test was conducted on the cantilever bending force known as the greatest force applied to superior locking plates.

Results:

The mean greatest stress under the cantilever bending force was significantly greater than other loading forces. The highest stress site was the screw hole edge on the fracture site in both models under the cantilever bending and axial compression forces. Under the axial torsional force, the maximum stress point was the lateral first screw hole edge. The ultimate plate stress of the with LSC model is completely lower than that of the without LSC model. According to the validation test, the stiffness, ultimate load, and yield load of the with LSC model were higher than those of the without LSC model.

Conclusions:

Therefore, inserting an LSC into an empty screw hole in the fracture area reduces the maximum stress on an LCP and improves biomechanical stability.
A case report of IgG4-related respiratory disease with pleural effusion and a literature review
Authors: Guo Qing , Ren Yue , Wang Quanyi , Pei Hongyun , Jiang Shenghua
Published: August 2022

Rationale:

IgG4-related respiratory disease (IgG4-RRD) is a chronic autoimmune disease that affects the respiratory system and organs outside the respiratory system. This study explored the diagnosis and treatment of a case of IgG4-RRD with unilateral pleural effusion diagnosed using medical thoracoscopy, and provides an associated literature review. This report summarizes the clinical characteristics of IgG4-RRD involving the pleura to improve the diagnosis of this disease.

Patient concerns:

A 39-year-old man presented with a 2-week history of cough and chest tightness. Both physical examination and imaging supported the presence of left pleural effusion.

Diagnosis:

Medical electronic thoracoscopy was performed to obtain a pleural biopsy, which showed lymphoplasmacytic infiltration, 40 IgG4+ plasma cells per High Power Field (HPF) on microscopy, IgG4/IgG ratio >50%, phlebitis obliterans, and storiform fibrosis. The final diagnosis was IgG4-RRD.

Interventions and outcomes:

The patient was treated with methylprednisolone, after which his symptoms improved, and he was discharged. Oral hormone therapy was continued outside the hospital. After 4 months, the patient returned to the hospital and his condition had improved significantly.

Lessons:

Pleural involvement in IgG4-RRD is rare, and its diagnosis depends on pleural biopsy. Thoracoscopy usually reveals pleural thickening, pleural nodules, and milky white plaques.
Expression of chemokine CXCL8/9/10/11/13 and its prognostic significance in head and neck cancer
Authors: Zhao Zhenyu , Ma Yuyu , Lv Jie , Maimaiti Naifeisha , Zhang Jingyi , Aibibula Madinaimu , Gong Zhongcheng , Ling Bin
Published: August 2022

Background:

Head and neck cancer (HNC) is a very popular cancer, with many primary sites and pathological types, at the top of the list of tumors. Chemokines are a class of small molecular basic proteins, whose N-terminal cysteine residues can be divided into four subunits by location and number, which significantly enhances the expression level in all kinds of cancers. However, in HNC, especially in head and neck squamous cell carcinoma, the chemokine CXCL8/9/10/11/13 has not been clearly explored for its diagnosis and prognosis.

Methods:

The ONCOMINE database was used to analyze the expression of chemokine family in various cancers. After CXCL8/9/10/11/13 was screened out, the expression of CXCL 8/9/11/13 in patients with HNC/normal people were analyzed by UALCAN database. The expression and pathological stages of CXCL 8/9/10/13 in HNC tissues were analyzed by the GEPIA database, and the relationship between its mRNA expression and the overall survival (OS) time of patients with HNC was analyzed by Kaplan–Meier plotter database. In addition, 171 co-expressed genes significantly related to CXCL8/9/10/11/13 mutation were screened by online tool cBioPortal, and the protein interaction network of these genes was constructed by STRING database. Finally, the potential functions of CXCL8/9/10/11/13 and its 171 co-expressed genes were explored by the enrichment and analysis function of David database.

Results:

Transcriptional expression of chemokine 8/9/10/11/13 was significantly increased in patients with HNC. Clinical stage of patients with HNC was significantly correlated with overexpression of CXCL9/10/11. In addition, the chemokine CXCL8/9/10/13 was significantly correlated with over-survival of patients with HNC, so it could be distinguished between short-term and long-term survival of patients with HNC. In conclusion, CXCL8/9/10/11/13 closely connected with the expression and prognosis of HNC.

Conclusion:

In this study, our results suggest that chemokine CXCL8/9/10/11/13 may play a critical role in the development of HNC, and, according to relevant data, it may affect the survival and prognosis of patients with HNC.
Fever as a first presentation of castration-resistant prostate cancer: A case report
Authors: Oh Tae Hoon , Park Seung Chol
Published: August 2022

Rationale:

Cancer is a well-recognized cause of fever, which is related to cytokines produced by malignant cells. Prostate cancer presenting with fever and other inflammatory markers as a paraneoplastic syndrome rarely occurs.

Patients concerns and diagnoses:

We describe the case of high fever and lower-urinary tract symptoms that progressed 1 month prior to presentation. A 78-year-old man had been diagnosed with prostate cancer 8 months ago. He received androgen deprivation therapy with leuprolide acetate 22.5 mg for every 3 months. Castration-resistant prostate cancer was diagnosed due to elevated prostate specific antigen (1639 ng/mL) and cancer fever.

Intervention:

The patient received docetaxel-based systemic chemotherapy 50 mg/mm2 biweekly. Naproxen 500 mg was administered twice a day.

Outcomes:

After one cycle of systemic chemotherapy, the patient had no major side effects, no more fever was observed, and the systemic condition improved.

Conclusion:

Differentiating cancer-related fever from infection-related fever is important for appropriate patient management. In this case, fever appeared as the first symptom of castration-resistant prostate cancer and was managed by naproxen and resolved with systemic chemotherapy.
Efficacy and safety of integrated traditional Chinese and Western medicine for the treatment of infant bronchiolitis: A systematic review, meta-analysis and GRADE evaluation
Authors: Wang Hao , Liu Xiaoying , Wu Yabin , Yang Chune , Chen Xiuzhen , Wang Wei
Published: August 2022

Background:

Infant bronchiolitis has a high death rate in severe cases. In China, traditional Chinese medicine (TCM) is commonly used to treat infant bronchiolitis. However, it has not received enough international attention.

Objective:

We aimed to assess the efficacy and safety of integrated TCM and Western medicine for treating infant bronchiolitis.

Methods:

We conducted a systematic review through 7 databases that included randomized controlled trials on integrated TCM and Western medicine for treating bronchiolitis, published in English or Chinese before February 4, 2021. To assess the risk of bias, the Cochrane Collaboration tool was employed to determine the quality of the included studies. We investigated clinical efficacy endpoints, hospitalization time, rates of recurrence, and adverse reactions and meta-analyzed the odds ratio (OR), mean difference (MD), and relative risk (RR), respectively. We assessed the overall certainty of the effect estimates using the GRADE approach. This study is registered with PROSPERO (CRD42021245294). Ethical approval is not required.

Results:

Forty-six studies (6427 children) were available for inclusion. We used 41 (5490 participants), 11 (1350 participants), 5 (1083 participants), and 11 (1295 participants) studies to analyze clinical efficacy endpoints (OR: 3.31; 95% confidence interval [CI]: 2.93, 3.74; P < .5), hospitalization time (MD: –2.10; 95% CI: –2.87, –1.34; P < .5), recurrence rate (RR: 0·41; 95% CI: 0.30, 0.56; P < .01), and adverse reaction rate (RR: 0.87; 95% CI: 0.55, 1.39; P = .57), respectively.

Conclusions:

Integrated TCM and Western medicine is superior to Western medicine alone for treating bronchiolitis in terms of clinical efficacy, hospitalization time, and recurrence rate, with no increase in the adverse reaction rate. TCM is useful as an alternative therapy for viral bronchiolitis. Although further studies are needed to establish specific protocols for the use of TCM in clinical practice, these results may strengthen guideline recommendations regarding the use of TCM.
Development and validation of a machine learning-based model for postoperative ischemic stroke in middle-aged and elderly patients with hip or knee arthroplasty
Authors: Dai Danfeng , Tu Sijia , Gao Zhichao
Published: August 2022

Postoperative ischemic stroke in middle-aged and elderly patients with hip or knee arthroplasty remains a major postoperative challenge, little is known about its incidence and risk factors. This study sought to create a nomogram for precise prediction of ischemic stroke after hip or knee arthroplasty.

Discharge data of all middle-aged and elderly patients undergoing primary hip or knee arthroplasty from May 2013 to October 2020 were queried. These patients were then followed up over time to determine their risk of ischemic stroke. Clinical parameters and blood biochemical features were analyzed by the use of univariable and multivariable generalized logistic regression analysis. A nomogram to predict the risk of ischemic stroke was constructed and validated with bootstrap resampling.

Eight hundred twenty-eight patients were included for analysis; Fifty-one were diagnosed with ischemic stroke. After final regression analysis, age, the neutrophil-to-lymphocyte ratio (NLR), a standard deviation of red blood cell distribution width, American Society of Anesthesiologists, low-density lipoprotein, and diabetes were identified and were entered into the nomogram. The nomogram showed an area under the receiver operating characteristic curve of 0. 841 (95% confidence interval [CI], 0.809–0.871). The calibration curves for the probability of ischemic stroke showed optimal agreement between the probability as predicted by the nomogram and the actual probability (Hosmer-Lemeshow test: P = .818).

We developed a practical nomogram that can predict the risk of ischemic stroke for middle-aged and elderly patients with hip or knee arthroplasty. This model has the potential to assist clinicians in making treatment recommendations.
Proximal fibular osteotomy relieves pain in spontaneous osteonecrosis of the knee: A retrospective study
Authors: Chen Yu-Sheng , Ang Min-De , Yang Chyun-Yu , Chang Chih-Wei
Published: August 2022

Spontaneous osteonecrosis of the knee (SONK) causes knee pain and joint motion limitation. Ischemia or insufficiency fracture may be the cause, but no consensus has been developed. Proximal fibular osteotomy (PFO) has been reported to relieve pain from osteoarthritis through medial compartment decompression. We reviewed the effect of this procedure on medial compartment SONK patients and explored clinical and radiological results.

Since January 2018 to January 2020, the data of 12 knees (8 right and 4 left) from 11 SONK patients (9 women and 2 men) who received PFO were analyzed. The average age was 61.5 years. The diagnosis of SONK was established through weight-bearing anterior–posterior radiographs or magnetic resonance imaging (MRI). Visual analog scale (VAS) scores, Oxford knee score (OKS), Femorotibial angle (FTA), medial joint space, and lateral joint space were documented preoperatively and at follow up visits. Outcome assessment for the clinical and radiographic data was reviewed at 12- and 24-month follow-up visits.

The mean follow up period was 33 months. All patients were able to walk with or without cane assistance the day after surgery. Both VAS score and OKS (preoperative: 6.6 ± 0.9 and 24.7 ± 3.8, respectively) improved significantly at the 12-month follow-up, and to 24-month follow-up (3.6 ± 1.3 and 35.6 ± 4.5, respectively, P < .05). Medial joint space ratio increased from 0.36 to 0.50 (P < .05). Changes of FTA were insignificant at any point of follow up. Four patients underwent follow-up MRI, and a decrease in the osteonecrotic area was clearly observed in 2 patients.

By achieving medial knee decompression, PFO allowed quick weight-bearing recovery, pain relief, and improvement in knee function in SONK patients.
The effect of trajectory of serum uric acid on survival and renal outcomes in patients with stage 3 chronic kidney disease
Authors: Lee Chia-Lin , Chen Cheng-Hsu , Wu Ming-Ju , Tsai Shang-Feng
Published: August 2022

Uric acid (UA) is associated with renal disease and patient survival, but the causal associations remain unclear. Also, the longitudinal UA control (trajectory) is not well understood.

We enrolled 808 subjects diagnosed with stage 3 chronic kidney disease from 2007 to 2017. We plotted the mean UA over a period of 6 months with a minimum requirement of 3 samples of UA. From the sampled points, we generated an interpolated line for each patient by joining mean values of UA levels over time. Using lines from all patients, we classified them into 3 groups of trajectories (low, medium, and high) through group-based trajectory modeling, and then we further separated them into either treatment or nontreatment subgroups. Due to multiple comparisons, we performed post hoc analysis by Bonferroni adjustment. Using univariate competing-risks regression, we calculated the competing risk analysis with subdistribution hazard ratio of possible confounders.

All of the 6 trajectories appeared showed a gradual decline in function over time without any of the curves crossing over one another. For all-cause mortality risk, none of the variables (including age, gender, coronary arterial disease, cerebrovascular disease, diabetes mellitus, renin–angiotensin–aldosterone system inhibitors, trajectories of UA, and treatment of UA) were statistically significant. All 6 trajectories appeared as steady curves without crossovers among them over the entire period of follow-up. Patients with diabetes mellitus were statistically more likely to undergo dialysis. The only trend was seen in the on-treatment trajectories, which showed lower risks for dialysis compared to their nontreatment trajectories. There was no effect of UA control on survival.

Initial treatment of UA is crucially important for UA control. However, the long-term effects on patients and renal survival appeared to be minor and without statistical significance.
Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis
Authors: Sukmanee Jarawee , Liabsuetrakul Tippawan
Published: August 2022

Objective:

There are limited data on the optimal timing and frequency of postpartum follow-up visits after hypertensive disorders of pregnancy (HDP) for primary prevention and early detection of cardiovascular diseases (CVDs) in high-risk women. We aimed to evaluate the risk of cardiovascular outcomes later in life in women with prior HDP in different years postpartum and in preeclamptic women with severe features, or early onset of preeclampsia.

Methods:

We searched MEDLINE, Cochrane Library, Web of Science, and Scopus without language restriction for relevant articles published from inception to March 16, 2022. We included prospective and retrospective cohort studies assessing hypertension, ischemic heart disease, heart failure, venous thromboembolism, peripheral vascular disease, stroke, dementia, composite cardiovascular and/or cerebrovascular diseases, and mortality after 6 weeks postpartum, in women with prior HDP compared with controls. Two authors independently selected and appraised the studies. Article quality was independently assessed using the Newcastle-Ottawa Scale (NOS). Random-effect models were used for meta-analysis. Stratified analyses based on years postpartum, severity, and onset of preeclampsia were performed.

Results:

We included 59 studies for qualitative review, of which 56 were included in quantitative meta-analysis, involving 1,262,726 women with prior HDP and 14,711,054 controls. Women with prior HDP had increased risks of hypertension (relative risk [RR] 3.46, 95% confidence interval [CI]: 2.67–4.49), ischemic heart disease (RR 2.06, 95% CI: 1.38–3.08), and heart failure (RR 2.53, 95% CI: 1.28–5.00) later in life, compared with those with normotensive pregnancies. The risk of hypertension was highest during 5 years postpartum (RR 5.34, 95% CI: 2.74–10.39). Compared with normotensive pregnancies, the risk of future CVDs significantly increased in preeclamptic women.

Discussion:

A history of HDP is associated with approximately 2- to 4-fold increase in the risk of CVDs. Screening for CVDs and their risk factors in women with prior HDP since delivery, especially the first 5 years after delivery is suggested for early detection and appropriate management. Evidence on the risks of CVDs in preeclampsia with severe features and early onset of preeclampsia is limited due to having few studies and high heterogeneity.

Funding:

The Royal Golden Jubilee PhD Program–RGJ (PHD/0183/2561); Thailand Science Research and Innovation (TSRI) Research Career Development Grant–RSA (RSA6180009); Targeted Research Grants Program of the Faculty of Medicine, Prince of Songkla University, Thailand.

Registration:

CRD42020191550
Effects of fascia iliaca compartment block as an adjunctive management to parecoxib for pain control after total hip arthroplasty
Authors: Li Xiao-yan , Zhang Liang , Ding Yu-mei , Wang Cai-xia , Qiu Yi
Published: August 2022

Background:

This retrospective study investigated the effects of fascia iliaca compartment block (FICB) as an adjunctive management to parecoxib for pain control after total hip arthroplasty (THA).

Methods:

A total of 72 patient records of THA were included in this retrospective study. All patients received parecoxib and were allocated to either the treatment group (n = 36) or the control group (n = 36). In addition, patients in the treatment group underwent FICB. The primary outcome was pain intensity measured using a resting and moving visual analog scales (VASs). The secondary outcomes were inflammatory factors (interleukin 6 and C-reactive protein) and occurrence rate of adverse events.

Results:

Patients in the treatment group had better outcomes in the resting VAS (12 hours, P < .01; 24 hours, P < .01; 36 hours, P = .01; 72 hours, P = .03), moving VAS (12 hours, P < .01; 24 hours, P < .01; 36 hours, P = .02; 72 hours, P = .02), serum interleukin 6 (P < .01), and C-reactive protein (P < .01) than those in the control group at different time points. In addition, there were no significant differences in the occurrence rate of adverse events.

Conclusion:

The findings of this study demonstrated that the effects of FICB as an adjunctive management to parecoxib are superior to those of parecoxib alone for pain control after THA.