bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating microRNA-208 family as early diagnostic biomarkers for acute myocardial infarction
Authors: Wang Jia , Xu Liwenjing , Tian Lu , Sun Qiyu
Published: December 2021

Objective:

Many recent studies have demonstrated that serum miRNA-208 (miR-208) could be a powerful biomarker in the early diagnosis of acute myocardial infarction (AMI). However, the result of previous studies was not accurate due to the small sample sizes and controversial issues. Therefore, this study was performed to investigate the relationship between the expression levels of miR-208 and AMI.

Materials and methods:

According to the inclusion and exclusion criteria, a preliminary literature search was performed. The study was based on articles published in PubMed, Embase, Cochrane databases before September 30, 2019. Two staff members extracted data from the included articles for meta-analysis. These data were analyzed for sensitivity, specificity, diagnostic odds ratio, and summary receiver operator curve (SROC) analyses.

Results:

This study included 13 pieces of literature, which contains 1703 patients with AMI and 1589 controls. The main results of our meta-analysis were as follows: The pool sensitivity and specificity of miR-208 for diagnosing AMI was 83% and 97%. The area under the SROC curve (AUC) was 93%. Mir-208 had a highly effective diagnostic capacity to distinguish AMI from chest pain patients with an AUC of 93%.

Conclusions:

The results showed that circulating miR-208 was a reliable biomarker both for diagnosting ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). MiR-208 was sufficient to distinguish AMI patients with chest pain from healthy controls.
A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis
Authors: Jin Hui , Zuo Hao , Xu Rui , Ji Youbo , Wang Zhonghan
Published: December 2021

Rationable:

Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane.

Patient concerns:

The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.

Interventions:

Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient's Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment.

Diagnoses:

Four patients with knee osteoarthritis.

Outcomes:

After treatment, the patient's VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.
Effects of nutritional support combined with insulin therapy on serum proteins, inflammatory factors, pentraxin-3, and serum amylase levels in patients with diabetic ketoacidosis complicated with acute pancreatitis
Authors: Yin Chao , Lu Songtao , Wei Dongmei , Xiong Juwen , Zhu Lishuang , Yan Shaoru , Meng Rui
Published: December 2021

To explore the effects of nutritional support combined with insulin therapy on serum protein, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), pentraxin-3 (PTX-3), and serum amylase (AMS) levels in patients with diabetic ketoacidosis complicated with acute pancreatitis.

A total of 64 patients with diabetic ketoacidosis complicated with acute pancreatitis admitted to our hospital from January 2018 to February 2019 were enrolled in this prospective study. They were divided into the study group and the control group according to the random number table method, with 32 patients in each group. Patients in the study group were given nutritional support combined with insulin therapy, and patients in the control group were given insulin therapy.

There were no significant differences in general data including age, gender, body mass index, course and type of diabetes, acute physiology and chronic health evaluation II, RANSON, CT grades between the 2 groups before treatment (all P > .05). After 7 days of treatment, the clinical efficacy of the study group was significantly higher than that of the control group (study group vs control group, 94.44% vs 75.00%, P < .05). After 7 days of treatment, the levels of prealbumin and albumin in the study group were significantly higher than those in the control group (P < .05). After 7 days of treatment, the levels of PCT, CRP, TNF-α, PTX-3, and AMS in the 2 groups were significantly lower than those before treatment (P < .05), and the levels of PCT, CRP, TNF-α, PTX-3, and AMS in the study group were significantly lower than those in the control group. After 7 days of treatment, the levels of IgG, IgM, and IgA in the 2 groups were significantly higher than those before treatment, and the levels of IgG, IgM, and IgA in the study group were significantly higher than those in the control group (P < .05).

Nutritional support combined with insulin is obviously effective in the treatment of diabetic ketoacidosis complicated with acute pancreatitis, which can improve serum protein levels, reduce inflammatory response, improve immune function, and is worthy of clinical application.
Clinical insights into hematologic malignancies and comparative analysis of molecular signatures of acute myeloid leukemia in different ethnicities using an artificial intelligence offering
Authors: Snowdon Jane L. , Weeraratne Dilhan , Huang Hu , Brotman David , Xue Shang , Willis Van C. , Lee Young Kyung , Jeon Kibum , Zang Dae Young , Kim Hyo Jung , Kim Ho Young , Han Boram , Kim Miyoung
Published: December 2021

Next generation sequencing generates copious amounts of genomics data, causing manual interpretation to be laborious and non-scalable while remaining subjective (even for highly trained specialists). We evaluated the performance of the artificial intelligence-based offering Watson for Genomics (WfG), a variant interpretation platform, in hematologic malignancies for the first time.

Next generation sequencing was performed for patients treated for various hematological malignancies at Hallym University Sacred Heart Hospital, South Korea, between December 2017 and August 2020 using a 54-gene panel. Both WfG and expert manual curation were used to evaluate the performance of WfG. Acute myeloid leukemia (AML) molecular profiles were compared between Koreans and other ethnic groups using a publicly available dataset.

Seventy-seven patients were analyzed (AML: 45, myeloproliferative neoplasms: 12, multiple myeloma: 7, myelodysplastic syndromes: 6, and others: 7). The concordance between the manual and WfG interpretations of 35 variants in 11 random patients was 94%. Among all patients, WfG identified 39 (51%) with at least 1 clinically actionable therapeutic alteration (i.e., a variant targeted by a United States Food and Drug Administration [US FDA]-approved drug, off-label drug, or clinical trial). Moreover, 46% of these patients (18/39) had genes that were targeted by a US FDA-approved therapy. WfG identified diagnostic or prognostic insights in 65% of the patients with no targetable alterations. In those with AML, FLT3-internal tandem duplications or tyrosine kinase domain mutations were less frequent among Koreans than among Caucasians (6.7% vs 30.2%, P < .001) or Hispanics (6.7% vs 28.3%, P = .005), suggesting ethnic differences.

Variant interpretation using WfG correlated well with manually curated expert opinions. WfG provided therapeutic insights (including variant-specific drugs and clinical trials that cannot easily be provided by expert manual curation), as well as diagnostic and/or prognostic information.
Use of rivaroxaban in sickle cell disease and venous thromboembolism
Authors: Rozi Waail , Ali Elrazi Awadelkarim Hamid , Al-Mashdali Abdulrahman F. , Abdelrazek Mohamed , Yassin Mohamed A.
Published: December 2021

Introduction:

Sickle cell disease (SCD) is a hematological disorder characterized by sickling of red blood cells. Patients are at increased risk of venous thromboembolism. There are no guidelines for the management of venous thromboembolism in sickle cell disease specifically in terms of the anticoagulant of choice.

Patient concerns:

Here, we report a case of a 30-year-old lady with past medical history of sickle cell disease who came with chest pain and shortness of breath.

Diagnosis:

We found that she has bilateral pulmonary embolism (PE).

Intervention:

She was started on rivaroxaban.

Outcome:

The patient was followed for 18 months, she did not suffer from recurrence of PE, and she did not develop any complications related to rivaroxaban.

Conclusion:

We concluded that rivaroxaban is effective in treating PE in sicklers and also it is safe.
The association between EKG abnormalities and the development of microalbuminuria in type 2 diabetes
Authors: Chang Yu-Kang , Fan Hueng-Chuen , Hsu Chih-Cheng , Lim Paik-Seong
Published: December 2021

Microalbuminuria is associated with both with chronic kidney disease and various cardiovascular abnormalities. Given the common use of electrocardiograms (EKGs) in diagnosing cardiovascular dysfunction, this study is analyzing the relationship between EKG abnormalities and diabetic nephropathy in type 2 diabetes mellitus (DM) patients. The enrollments of this study were from the 10-year follow-up data (2003–2012) of the Diabetes Management through an Integrated Delivery System project. All study subjects underwent at least 1 EKG measurement. The urinary microalbuminuria was recorded annually. The logistic regression model was used to evaluate the association between EKG abnormalities and the occurrence of diabetic nephropathy in type 2 DM patients. The total of 1189 patients with type 2 DM are included in this study and a total of 552 patients had microalbuminuria during a 10-year follow-up. A significantly higher odds ratio of microalbuminuria occurrence (4.85) was found in the patients with premature supraventricular contraction or tachycardia compared to those without EKG abnormalities. The odds ratios of microalbuminuria occurrence were 1.00, 2.43, 2.64, and 2.98, respectively, for patients with insulin resistance in the Q (quartile) 1(as the reference), Q2, Q3, and Q4, respectively. Our findings can serve as a reference for the association between EKG abnormalities and the development of microalbuminuria in type 2 diabetes.
Etiology of serum vitamin B12 elevation 1 month after bariatric surgery
Authors: Guo Pengsen , Yang Huawu , Zhou Jinhua , Mao Rui , Zhan Dafang , Zhang Tongtong , Yuan Jiang , Ou Yanxi , Liu Yanjun
Published: December 2021

Few studies have reported an increase in vitamin B12 (VitB12) levels after bariatric surgery. This study reports the phenomenon and adverse reactions of serum VitB12 elevation 1 month after surgery and explores the possible etiologies.

Retrospective analysis was performed on VitB12 data for 112 patients from January 2018 to October 2019. Then, 87 patients were included between November 2019 and August 2020. They were divided into 2 groups according to the level of VitB12 after surgery, and the demographic and clinical data were analyzed. Then, LASSO regression model analysis and multiple logistic regression analysis were performed to explore the risk factors for VitB12 elevation after surgery.

Retrospective data showed that the VitB12 level was significantly increased 1 month after surgery. Comparison of data between the 2 groups found that more patients also had diabetes in the nonelevated group. The postoperative folic acid and VitB12 levels of the elevated group were significantly higher than those of the nonelevated group. More patients had concurrent constipation in the elevated group than in the nonelevated group. Two meaningful variables in LASSO regression analysis were incorporated into the multivariate logistic regression analysis, and constipation was found to be an independent risk factor for the increase in VitB12 after surgery. Of the 199 patients in this study, 111 patients had elevated VitB12 levels after surgery. Among them, 7 patients had peripheral nerve symptoms.

Constipation is an independent risk factor for increased VitB12 levels after surgery. High levels of VitB12 may cause some peripheral nerve symptoms. Therefore, it is necessary to pay attention to patients with postoperative constipation, monitor their VitB12 level as soon as possible, and take measures to improve constipation to avoid some adverse reactions caused by elevated VitB12 levels.
A patient with COVID-19 and bleeding complications due to neurofibromatosis type 1 during VV-ECMO
Authors: Shimoyama Keiichiro , Azuma Kazunari , Oda Jun
Published: December 2021

Rationale:

The many deaths from coronavirus disease (COVID-19) since 2019 have caused global concern. Effective treatment has not yet been established; supportive care is the main treatment. It has been suggested that veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be effective in severe cases that do not respond to ventilator management.

Patient concerns and diagnosis:

We report the case of a 68-year-old woman with severe respiratory failure due to COVID-19 who was treated with VV-ECMO but suffered from bleeding complications. She presented with multiple café-au-lait lesions and neurofibromas on her skin and was diagnosed pathologically as having neurofibromatosis type 1(NF1).

Interventions and outcomes:

Although she received appropriate anticoagulation therapy with heparin at the initiation of VV-ECMO, she had 5 episodes of severe bleeding, each requiring transcatheter arterial embolization and massive transfusion. In patients with NF1, vascular fragility has been noted due to vascular infiltration of neurofibromas and degeneration of vascular structures. Therefore, the causes of frequent bleeding complications may be related to the fragility of blood vessels in patients with NF1. VV-ECMO in patients with NF1 is likely to result in frequent bleeding complications and the need for massive transfusion.

Lesson:

We propose non-anticoagulation treatment strategy for the management of VV-ECMO in patients with NF1. Especially under the COVID-19 pandemic, more careful consideration should be given to the indications for VV-ECMO in patients with NF1.
Leave me out: Patients’ characteristics and reasons for opting out of a pragmatic clinical trial involving medication adherence
Authors: Sandy Lisa Caputo , Glorioso Thomas J. , Weinfurt Kevin , Sugarman Jeremy , Peterson Pamela N. , Glasgow Russell E. , Ho P. Michael
Published: December 2021

Opt-out procedures are sometimes used instead of standard consent practices to enable patients to exercise their autonomous preferences regarding research participation while reducing patient and researcher burden. However, little is known about the characteristics of patients who opt-out of research and their reasons for doing so. We gathered such information in a large pragmatic clinical trial (PCT) evaluating the effect of theory informed text messages on medication adherence.

Eligible patients, identified through electronic health records, were sent information about the study and provided with an opportunity to opt-out. Those opting out were asked to complete a voluntary survey regarding their reasons for doing so. Demographic data were compared among patients opting-out vs those included in the study using chi-squared tests and a log binomial regression model.

Of 9046 patients receiving study packets, 906 (10.0%) patients returned opt-out forms. Of those, 451 (49.8%) returned the opt-out survey. Patients who opted out were more likely to be older, white, and nonHispanic than those who were included in the PCT. Survey respondents expressed high levels of trust in their health care providers, research, and system. Nearly half (46.6%) reported concerns about time as a reason to opt-out.

In this PCT, 10% of patients receiving packets opted out, with significant differences in age, race, gender, and ethnicity compared to those included. Future trials should further investigate representativeness and reasons patients choose to opt-out of participating in research.
Ovarian high-grade serous carcinoma with elevated β-human chorionic gonadotropin
Authors: Zhong Yi , Chen Xing , Huang Yan , Jiang Yi , Chen Ting , Nie Xianglin , Cheng Wenjun
Published: December 2021

Rationale:

Human chorionic gonadotropin (hCG) is a glycoprotein hormone secreted by the syncytiotrophoblasts of the placenta. However, hCG (particularly β-hCG) is also expressed in many normal nontrophoblastic tissues. Here, we report the case of a 50-year-old woman diagnosed with ovarian high-grade serous carcinoma with elevated β-hCG, which was insensitive to chemotherapeutic drugs and had a poor prognosis.

Patient concerns:

A 50-year-old woman with abdominal distention was admitted to our hospital. Pelvic computed tomography and magnetic resonance imaging were highly suggestive of multiple metastases of ovarian cancer. Surprisingly, an elevation in β-hCG levels was also measured.

Diagnosis and interventions:

The patient underwent laparoscopic examination and was diagnosed with high-grade serous ovarian carcinoma. After 2 prior chemotherapies with paclitaxel and carboplatin, the patient underwent cytoreductive surgery and continued receiving chemotherapy. However, recurrent lesions were observed during the period of chemotherapy, and the level of β-hCG increased. Alternative chemotherapy with liposomal doxorubicin was administered, but it also had a poor therapeutic effect.

Outcomes:

The progression was rapid with a continuous increase in β-hCG levels, and the patient died 9 months after surgery.

Lessons:

Gynecologists should be aware of women with ovarian carcinoma with an elevated β-hCG level, which suggests a poor prognosis.
Early outcomes and long-term survival after kidney transplantation in elderly versus younger recipients from the same donor in a matched-pairs analysis
Authors: Jankowska Magdalena , Bzoma Beata , Małyszko Jolanta , Małyszko Jacek , Słupski Maciej , Kobus Grażyna , Włodarczyk Zbigniew , Rutkowski Bolesław , Dębska-Ślizień Alicja
Published: December 2021

The elderly are the fastest-growing population on waiting lists for kidney transplantation (KTx). Recognized barriers to KTx in the elderly is early post-transplant mortality and morbidity. To analyze the outcomes of KTx in recipients older than 60 years and, simultaneously, in their younger paired recipients, receiving a graft from the same donor.

We included 328 kidney transplant recipients in the study. The elderly kidney transplant recipients (EKT) group included 164 patients aged 65 standard deviation (SD4) years. They were paired with younger kidney transplant recipients (YKT) aged 45 (SD12) years.

The studied groups (EKT vs YKT) did not differ from the graft function estimated 1 year after the transplantation (50.7 mL/min vs 54.0 mL/min), while the estimated glomerular filtration rate decline was significantly faster in the YKT group. One-year patient survival (93.9% vs 97.0%), 1-year graft survival (90.4% vs 82.3%), and incidences of delayed graft function and acute rejection did not differ between the EKT and YKT groups. Significantly more cardiovascular complications and post-transplant diabetes mellitus were noticed in the EKT group. The long-term patient and graft survivals were poorer in the EKT group versus the YKT group, but death-censored graft survivals were the same. After having excluded donor-derived graft factors, there were no differences in the first-year outcome of KTx between recipients younger and older than 60 years. As life expectancy is lower in the EKT group, the probability of patient and graft survival was also significantly lower in this group. However, death-censored graft survival was not different in the EKT and YKT groups.
Comparison of concordance between chuna manual therapy diagnosis methods (palpation, X-ray, artificial intelligence program) in lumbar spine
Authors: Lee Jin-Hyun , Woo Hyeon-Jun , Lee Jung-Han , Kim Joong-Il , Jang Jun-Su , Na Young Cheol , Kim Kwang-Ryeol , Park Tae-Yong
Published: December 2021

Introduction:

Chuna manual therapy (CMT) is a type of manual medicine practiced by Korean medical doctors in South Korea. Spinal diagnosis in CMT uses a system that applies manual diagnostic and X-ray tests to detect specific vertebral malpositions, based on the relative alignment across vertebral bodies. Recently, artificial intelligence (AI) programs have been developed to assist in the radiological diagnosis of CMT using X-ray images. Nevertheless, a few clinical studies have reported on the concordance between diagnosticians, diagnostics methodologies, and the use of AI programs for diagnosing CMT. At present, the evidence to support CMT diagnosis is insufficient. This study thus aims to overcome such limitations by collecting and comparing CMT diagnostic data from experts and non-experts through manual diagnosis, X-ray test, and images obtained using an AI program. The study aims to search for CMT diagnosis methods with more outstanding rationality and consistency and to explore the potential use of AI-based CMT diagnosis programs.

Methods/design:

This study will be conducted as an exploratory, cross-sectional, prospective observational study that will recruit 100 non-specialist subjects. Each subject will submit a signed consent after the screening test and undergo L-spine standing AP & lateral X-ray imaging. Manual CMT diagnosis will be performed by 3 CMT experts according to the standard operation procedure (SOP). The X-ray images of the 100 subjects will subsequently be used to make the CMT radiological diagnoses according to the same SOP by the CMT expert group (n = 3) and CMT non-expert group (n = 3). Among the subjects, those in the non-expert group will receive another CMT radiological diagnosis with spinal data obtained using the AI program, approximately 1 month from after initial diagnosis.

Based on the collected diagnostic data, within- and between-group concordance levels will be assessed for each diagnostic method. The verified level of concordance will be used to test the potential use of CMT diagnostic method and CMT AI programs with high levels of rationality and consistency.

Ethics and dissemination:

This trial has received complete ethical approval from the Wonkwang University Korean Medicine Hospital (IRB 2021–8). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.

Trial registration:

https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=M&pageSize=10&page=undefined&seq=20613&status=5&seq_group=20613, Identifier: KCT0006707.
The effect of acupoint therapy on sleep quality of hemodialysis patients
Authors: Xiong Gang , Hu Lijun , Hu Chenglian , Yao Yunhua
Published: December 2021

Background:

Hemodialysis patients usually have sleep disturbance at varying degrees, which seriously affects the therapeutic efficacy and quality of life. Therefore, improving the sleep quality of hemodialysis patients is the key during treatment. Acupoint therapy can improve the sleep quality of patients. However, guidelines for improving sleep quality of hemodialysis patients by acupoint therapy are scant. This study aims to evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients through a meta-analysis, providing clinical evidences.

Methods:

Randomized controlled trials (RCTs) reporting the effect of acupoint therapy on sleep quality in hemodialysis patients published before November 2021 will be searched in the China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, PubMed, Embase, The Cochrane Library, and Web of Science databases. Eligible literatures will be screened according to inclusion and exclusion criteria and assessed for quality using the Cochrane Risk of Bias Assessment Tool. Meta-analysis will be performed using Revman 5.4 software.

Results:

This study will evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients using the Pittsburgh Sleep Quality Index (PSQI).

Conclusion:

This study will provide a reliable evidence-based basis for conducting acupoint therapy to improve sleep quality in hemodialysis patients.
The effectiveness of Chinese herbal medicine for tic disorders in children and adolescents
Authors: Liu Li , Zhou Liang-An , Sun Ya-Lei
Published: December 2021

Background:

The tic disorders are common neuropsychiatric disorders that affects the growth and development of children and adolescents. Chinese herbal medicine is commonly used for the treatment of tic disorders. However, there is no consensus on the difference in clinical efficacy compared with routine treatment. Therefore, we plan to perform a systematic review and meta-analysis to review the clinical efficacy of Chinese herbal medicine for tic disorders.

Methods:

Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Bio-medical Database, and Wanfang database will be searched from their inception until March 31, 2021. The meta-analysis will be conducted with Review Manager 5.3 software to systematically review the clinical efficacy and safety of Chinese herbal medicine for tic disorders. The primary outcome will include the improvement rate (amount) of tic symptoms using related scales or methods, and the secondary outcome will include adverse events.

Results:

This analysis will provide useful information about clinical efficacy and safety of Chinese herbal medicine for tic disorders.

Conclusions:

Our study will generate strong evidence of Chinese herbal medicine for patients with tic disorders and provide suggestions for clinical practice.
MRI features of an atypical case of extraventricular neurocytoma
Authors: Liu Xiaoge , Yu Yaohan , Ma Liwei , Cheng Jingliang
Published: December 2021

Rationale:

Central neurocytoma occurring outside the ventricles is known as extraventricular neurocytoma (EVN). EVN is rare and its magnetic resonance imaging (MRI) findings vary greatly and overlap with the imaging features of other intracerebral primary tumors.

Patient concerns:

A 21-year-old woman with an intrauterine pregnancy of 18+2 weeks complained of dizziness and headache for 3 months.

Diagnosis:

A 8.6 cm × 5.8 cm × 3.7 cm space-occupying lesion was seen in the right frontal lobe on MRI, with mixed long signals on T1-weighted imaging and mixed slightly long signals on T2-weighted imaging, slightly hyperintense on T2-weighted imaging fluid attenuated inversion recovery images, and a large-scope long T1-weighted imaging and long T2-weighted imaging cystic component at the center of the lesion. A thick fence-like enhancement of the solid component at the periphery of the lesion was observed after injecting a contrast medium, while the internal cystic component was not enhanced. The MRI diagnosis was of glioma. The lesion was pathologically confirmed as an atypical central neurocytoma of the right frontal lobe.

Interventions:

Resection of the lesion and postoperative radiotherapy.

Outcomes:

The patient was lost to follow-up.

Lessons:

EVN can be considered as a differential diagnosis for lesions occurring in the cerebral hemispheres of young patients with cystic degeneration, thick fence-like enhancement, and peritumoral edema on MRI.
Early-stage serum Stanniocalcin 1 as a predictor of outcome in patients with aneurysmal subarachnoid hemorrhage
Authors: Jun Qin , Luo Weijian
Published: December 2021

Stanniocalcin-1 (STC1) takes part in anti-inflammatory and anti-oxidative processes, thus demonstrating neuroprotective properties. Early brain injuries associated with initial subarachnoid hemorrhage typically led to secondary cerebral infarction and poor outcomes. This retrospective study aimed to clarify the clinical significance of serum STC1 level in patients with subarachnoid hemorrhage.

We collected demographic information, comorbidities, neurological status in detail. All blood samples were collected on admission. Enzyme-linked immunosorbent assay kits were used to detect the serum level of STC1. Spearman analysis was used to explore the relationship between STC1 and clinical severity. Multivariate logistic regression was used to investigate the prognostic role of STC1 in patients with aneurysmal subarachnoid hemorrhage (aSAH). Receiver operating characteristic curve was performed to investigate the power of STC1 in predicting outcome in aSAH patients.

Serum STC1 concentration was significantly higher in aSAH patients than in healthy individuals. Serum concentration of STC1 positively correlated with Hunt-Hess grade (r = 0.62, P < .01) and Fisher grade (r = 0.48, P < .01), and negatively correlated with Glasgow Coma Scale on admission (r = −0.45, P < .01). Patients with delayed cerebral ischemia (DCI) had higher level of serum STC1 than those without DCI (13.12 ± 1.44 vs 8.56 ± 0.31, P < .01). Moreover, patients with poor outcome had higher concentration of STC1 than patients with good outcome (11.82 ± 0.62 vs 8.21 ± 0.35,P < 0.01). Results of univariate and multivariate logistic analysis revealed that Hunt-hess III–IV, DCI, and high STC1 level were independent risk factors associated with poor outcome of patients with aSAH. Further analysis revealed that combination of STC1 with Hunt-hess grade was more superior to 2 indicators alone in predicting clinical outcome of aSAH patients.

STC1 can be used as a novel biomarker in predicting outcome of patients with aSAH, especially when combined with Hunt-hess grade.
Giant mediastinal neuroendocrine tumor successfully resected after transarterial chemoembolization of drug-eluting embolic microspheres
Authors: Yu Qi , Li Zhen , Han Xinwei
Published: December 2021

Rationale:

Neuroendocrine tumors (NETs) in the mediastinum are extremely rare. No uniform solution currently exists for the treatment of mediastinal NETs.

Patient concerns:

We report the case of a 32-year-old man with symptoms of chest tightness, chest pain, cough, and panic.

Diagnoses:

Computed tomography showed that the mediastinum and right lung occupied a space with uneven enhancement. A needle biopsy revealed mediastinal NETs. An atypical carcinoid was diagnosed using immunohistochemistry.

Interventions:

The patient underwent 2 similar transarterial chemoembolizations of drug-eluting embolic microsphere procedures after 5 cycles of etoposide and cisplatin chemotherapy. The patient underwent successful surgical resection 2 months after the operation.

Outcomes:

The patient's quality of life was significantly improved, without chest tightness, chest pain, or other symptoms. At the 1-year follow-up, the patient had no tumor recurrence.

Lessons:

For large mediastinal NETs with poor chemotherapy effects, surgical resection is safe and feasible after down-staging treatment via arterial chemoembolization of drug-eluting embolic microspheres.
Febrile episode unmasking neuropsychiatric systemic lupus erythematosus with lytic lesions caused by secondary autoimmune myelofibrosis
Authors: Bratu Ionuţ-Flavius , Ribigan Athena Cristina , Mihailă-Bâldea Sorina , Badea Raluca , Stefan Daniela , Davidoiu Cristina , Casaru Bogdan , Antochi Florina
Published: December 2021

Rationale:

Systemic lupus erythematosus (SLE) is characterized by numerous immunological abnormalities that lead to multiorgan involvement. Central and peripheral nervous system manifestations are present in 8% to 92% of the cases of SLE. Furthermore, there have been reported cases of secondary autoimmune myelofibrosis associated with SLE.

Patient concerns:

We present the case of a 64-year-old female who was transferred from the Cardiology Department, where she was admitted for pericardial-pleural-peritoneal effusion after being discharged from another hospital following the resolution of a febrile episode. During hospitalization, she presented multiple oculomotor nerves palsies and weakness in the lower limbs. Serial cerebral magnetic resonance imaging (MRI) revealed extensive cerebral venous thrombosis. Nerve conduction studies showed sensory-motor axonal polyneuropathy. Thoracic MRI revealed a rare finding in patients with SLE – lytic lesions.

Diagnoses:

Extensive clinical, imaging, blood, and urine tests were performed. The patient exhibited pancytopenia, elevated inflammatory markers, hyperhomocysteinemia, mild hypoproteinemia, and severe proteinuria. The Hematology consultation ascertained that the peripheral blood smear and the bone marrow aspiration showed no alterations suggestive for a primary hematological disease and the thoracic vertebral-medullary MRI changes had a very low probability of representing osteolytic lesions in the context of plasma cells dyscrasia, but could not exclude their being result of a secondary autoimmune myelofibrosis. Immunology blood tests highlighted the presence of antinuclear antibodies and lupus anticoagulants. In this context, the Rheumatology consultation established the diagnosis of SLE with multiple complications.

Interventions:

The patient received treatment with cyclophosphamide.

Outcomes:

The ocular motricity problems and the paraparesis showed improvement. However, 1 week later, the patient developed weakness, dyspnea, and right lower quadrant abdominal pain. The abdominal-pelvic computed tomography scan indicated an acute right retroperitoneal hematoma with active bleeding for which she underwent arterial embolization of the spinal lumbar arteries with optimal result, but she died a few days later.

Lessons:

We chose to present this case in order to highlight the importance of interdisciplinarity in diagnosing and managing patients with SLE and multiorgan ailments, especially when faced with rare constellations of complications such as extensive cerebral venous thrombosis and osseous lytic lesions caused by secondary autoimmune myelofibrosis.
Cerebral large artery occlusion in chronic graft-versus-host disease
Authors: Li Ying , Gao Feng , Sun Wei , Wang Zhaoxia , Jin Haiqiang
Published: December 2021

Rationale:

Cerebral large artery occlusion in chronic central nervous system graft-versus-host disease after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was very scarce. We described a young patient with bilateral white matter lesions and symptomatic internal carotid artery occlusion after allo-HSCT with the history of aplastic anemia.

Patient concerns:

A 17-year-old girl with the history of aplastic anemia developed recurrent headache and sudden hemiplegia of right limbs 2 years after allo-HSCT.

Diagnoses:

She was diagnosed with skin chronic graft-versus-host disease 19 months after allo-HSCT. Brain magnetic resonance imaging showed bilateral subcortical white matter abnormal signals and hyperintensity of left fronto-parietal lobe on diffusion weighted imaging and corresponding hypointense apparent diffusion coefficients indicating acute infarction. CT angiography revealed thrombosis in left internal carotid artery. Carotid plaque high-resolution magnetic resonance imaging showed annular enhancement of vascular wall revealing signs of vasculitis.

Interventions:

Intravenous immunoglobulin, methylprednisolone, and anticoagulant therapy were used to treat the patient.

Outcomes:

The patient's symptoms gradually resolved and she could walk with assistance after 3 weeks before returned home.

Lessons:

Chronic graft-versus-host disease-associated vasculitis could involve cerebral large vessels which warrants further study.
Isolated tuberculosis of the lumbar facet joint
Authors: Wang Linan , Yang Zongqiang , Wang Chaoran , Zhu Xi , Shi Jiandang , Niu Ningkui
Published: December 2021

Rationale:

Spinal tuberculosis (TB) is the most common in bone and joint TB, of which vertebral TB is more common, while accessory TB is rare. The incidence of isolated adnexal lesions in spinal TB is 2% to 3%. It is difficult to distinguish the imaging changes of spinal adnexal TB from other types of spinal infections and spinal tumors, and the pathological diagnosis of spinal TB is often atypical. Here, we report a case of isolated lumbar facet joint TB.

Patient concerns:

A 64-year-old female patient had an 8-month history of low back pain, decreased pinprick sensation in the left anterior middle thigh area, weakening of the patellar tendon reflex of the left lower limb, and enhanced MRI of the lumbar vertebrae showed bone destruction at the left superior and inferior articular process of the lumbar 2 to 3 and the encapsulated calcification containing the lesion around the articular process. The enhanced scan showed solid part and septal enhancement, and the lesion protruded to the left and posterior side of the spinal canal, and the left posterior edge of the dural sac was compressed at the same level. Conservative treatment for 8 months was ineffective.

Diagnoses:

L2–3 vertebral lamina, facet joint, and intraspinal space-occupying Lamina TB.

Interventions:

The diagnostic treatment scheme for anti-TB drugs was routinely administered before the operation. Isoniazid (300 mg), rifampicin (450 mg), ethambutol (750 mg), and pyrazinamide (1500 mg) were administered orally once daily after breakfast for 1 month, as anti-TB treatment for 1 month. Posterior lumbar total laminectomy and decompression, pedicle screw internal fixation, TB focus debridement, lumbar intertransverse process bone graft fusion was performed 1 month later.

Outcomes:

The patient was relieved of symptoms after surgical treatment and anti-tubercular medication.

Lessons:

We present a case of isolated TB of the lumbar facet joint, which was initially diagnosed as L2–3 vertebral lamina, facet joint, and intraspinal space-occupying osteochondroma. For patients with long-term low back pain, it is suggested to follow-up with lumbar computed tomography and lumbar magnetic resonance imaging when conventional X-ray examination does not show any lesion. Despite its rarity, isolated TB of the lumbar facet joint should be highly suspected in elderly patients with pulmonary TB, low-grade fever, and waist pain.
Management of inflammatory bowel disease and serum level of infliximab in newborn exposed to anti-TNF therapy during pregnancy
Authors: de Aragão Maria Cecília , Beraldo Rodrigo Fedatto , Marcondes Mariana Barros , de Barros Jaqueline Ribeiro , Herrerias Giédre Soares Prates , Saad-Hossne Rogerio , Baima Júlio Pinheiro , Sassaki Ligia Yukie
Published: December 2021

Rationale:

Heightened inflammatory bowel disease (IBD) activity during pregnancy is associated with higher rates of preterm birth, miscarriage, and low birth weight. Therefore, its adequate treatment is essential, considering the risk–benefit of medication use. Although previous literature has described the management of IBD during pregnancy, few studies have assessed the pharmacokinetics of IBD drugs in the newborn. In this case report, we describe the management of ulcerative colitis during pregnancy and discuss the benefits of checking serum levels of infliximab in newborns exposed to the medication during pregnancy.

Patient concern:

A 37-year-old patient with ulcerative colitis in clinical and endoscopic remission had been undergoing treated with infliximab since 2008. The patient became pregnant in 2018.

Diagnosis and intervention:

Infliximab medication was discontinued at the 29th week of pregnancy.

Outcomes:

The pregnancy was uneventful, and the levels of infliximab in the umbilical cord were >20 μg/dL. Live vaccinations were postponed until the baby was 6 months old, when a new serum drug level proved to be undetectable.

Lessons:

Our case suggests that the use of infliximab is safe in pregnancy, and drug discontinuation could be considered from the 24th week of pregnancy onward to reduce placental transfer to the newborn in patients at low risk of relapse. Vaccines with live attenuated organisms should be delayed for at least 6 months or until the serum level of the medication is undetectable.
Coping styles play intermediary roles between resilience and clinical communication ability among nursing students in traditional Chinese Medical university
Authors: Li Ling , Hua Rongyu , Yang Lili
Published: December 2021

To prove the positive association between resilience and clinical communication ability among Chinese nursing students, and to determine whether coping styles play a mediating role in the relationship between them.

Four hundred and seventy-one nursing students from a traditional Chinese Medical university were enrolled in this study. They completed some questionnaires, which included the Chinese Version of the Simplified Coping Style Questionnaire (SCSQ), Connor-Davidson Resilience Scale Chinese Version, and Clinical Communication Ability Scale. Structural equation modeling was utilized to analyses the relationships between coping styles, resilience, and clinical communication ability.

Resilience was positively associated with clinical communication ability (P < .01). Coping styles which included positive coping and negative coping both significantly affected clinical communication ability (P < .01) and intermediated the relationship between resilience and clinical communication ability (P < .01).

Resilience is positively related to clinical communication ability among Chinese nursing students, and coping styles intermediated the relationship between them, which may provide scientific evidence to aid in developing intervention strategies to improve interpersonal skills.
Efficacy and safety of Xijiao Dihuang decoction in treating Henoch-Schönlein purpura
Authors: Kong Zhiqian , Zheng Jiaming , Wu Junwei , Ou Jianzhao , Zhou Xinyu , Huang Haiyan
Published: December 2021

Background:

Henoch-Schönlein purpura is one of the most common systemic vascular inflflammatory disease in childhood with purpuric rash, arthritis, renal involvement, and abdominal pain. As a treatment for it, Xijiao Dihuang decoction, a traditional herbal formula, has been used. The object of this systematic review and meta-analysis is to assess the effificacy and safety on Xijiao Dihuang decoction in treating allergic purpura.

Methods:

The following electronic databases will be systematically searched up to November 7, 2019 for eligible studies: The Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical LiteratureDatabase (CBM), the Chinese Scientifific Journal Database (VIP), andtheWanfang Database. Thetreatment group in the included studies will receive both routine western medicines and Xijiao Dihuang decoction, while the control group will receive routine western medicines. Data extraction and risk of bias assessments will be conducted by 2 independent reviewers. Heterogeneity will be assessed by I2 statistics, while reporting bias will be evaluated by funnel plots and Begg and Egger test. Sensitivity analysis and Subgroup analysis will be performed when necessary. Review Manager software (RevManV.5.3.0) and Stata will be used for all statistical analyses. Ethics approval is not required as no privacy data were involved. This systematic review and meta analysis will be published in a peer-reviewed journal.

Results:

This study could provide a systematically evaluated therapeutic efficacy and safety of XJDHD on patients with HSP via including RCTs that matches the needs. And we also expect to find predictors of treatment through subgroup analysis, helping patients with HSP detect as well as cope with the disease as early as possible.

Conclusion:

The conclusion of our study will provide the systematical review of the efficacy and safety of XJDHD on patients with HSP, and provide predictors of treatment.

PROSPERO registration number:

PROSPERO CRD 42018111293
Effects of mindfulness-based intervention on adolescents emotional disorders
Authors: Tang Dan-Feng , Mo Li-Qiong , Zhou Xin-Chu , Shu Jun-Hong , Wu Lei , Wang Dong , Dai Fei
Published: December 2021

Background:

The vulnerability of adolescents to emotional disorders such as stress, anxiety, anger, depression, and emotional breakdown is a matter of great concern and urgent need. Studies in several countries and regions have reported higher prevalence of depression, stress, and anxiety in adolescents. Several studies have shown that mindfulness-based interventions have an ameliorative effect on both emotional disorders and psychological problems in adolescents. The purpose of this study is to systematically analyze the effects of mindfulness-based intervention on emotional disorders and psychological problems in adolescents, and to provide a reasonable mindfulness-based intervention program for adolescents with emotional disorders.

Methods:

Electronic databases including Google Scholar, EMBASE, Web of Science, PubMed, the CNKI, the Chinese Science and Technology Periodical Database, VIP, Wanfang, and Cochrane Library. These databases will be searched to identify randomized controlled trials (RCTs) published before October 2021. Only Chinese and English literature will be included. We will use the criteria provided in Cochrane Handbook 5.3.0 for quality assessment and risk assessment and Revman 5.3 software for meta-analysis. The primary outcome are mainly evaluated by PHCSS, SDS and SAS in adolescents.

Conclusion:

The results of this study may provide a strong basis for improving emotional disorders and psychological problems in adolescents.

Systematic review registration: INPLASY2021110054.
The role of serum creatine kinase levels in anterior cervical spinal surgery
Authors: Sang Peiming , Ma Yanyan , Chen Binhui , Zhang Ming
Published: December 2021

This study aimed to describe change trends in serum creatine kinase (CK) values for patients undergoing anterior cervical spinal surgery and identify risk factors that affect the CK values perioperatively, intending to decrease the degree of the iatrogenic invasiveness of the procedure.

We retrospectively analyzed 122 patients undergoing anterior cervical spinal surgery from January 2019 to May 2020. For all patients, CK level was measured 1 day before the operation. Daily CK levels were evaluated on postoperative days 1 to 7. These data were analyzed in terms of age, gender, the use of microendoscopy during surgery, the number of cervical operative segments, and operative methods to determine whether these risk factors influenced postoperative CK increases.

A total of 122 patients were enrolled. The preoperative average CK level was 72.7 U/L, and the average CK levels were 130.6, 122.4, 99.1, 82.8, 73.7, 63.9, and 55.4 U/L from the postoperative day (POD) 1 to POD7, respectively. CK level changes on POD1 increased with the number of operated cervical segments. However, changes were not related to age, gender, microendoscopy, or the operative method.

Increased serum CK level was associated with the number of cervical operative segments, rather than age, gender, the use of microendoscopy, or the operative methods. These findings suggest that the number of cervical operative segments determined the degree of iatrogenic injury for anterior cervical spinal surgery.