bluuebunny/crossref_metadata_2025 huggingface dataset:
Case report of severe hypoglycemic alcoholic ketoacidosis: A possible pitfall in diagnosis of ketoacidosis
Authors: Okauchi Seizo , Tatsumi Fuminori , Takahashi Kaio , Katakura Yukino , Shimoda Masashi , Kohara Kenji , Kimura Tomohiko , Obata Atsushi , Nakanishi Shuhei , Mune Tomoatsu , Kaku Kohei , Kaneto Hideaki
Published: December 2022

Backgrounds:

Hypoglycemic alcoholic ketoacidosis is known to be one of the emergent diseases but its frequency is very low compared to hyperglycemic ketoacidosis or hyperosmolar hyperglycemic syndrome observed in subjects with diabetes mellitus.

Case presentation:

We experienced a case who had alcoholic ketoacidosis and severe hypoglycemia after drinking too much alcohol without taking enough food for a long period of time. In this subject, plasma glucose level was as low as 25 mg/dL, and ketone bodies, especially 3-hydroxybutyrate, were markedly increased. In addition, in blood gas analysis, severe acidosis was observed and anion gap was increased. These points were compatible with hypoglycemia alcoholic ketoacidosis.

Conclusions:

When we examine subjects with ketoacidosis and hypoglycemia, we should bear in mind the possibility of hypoglycemic alcoholic ketoacidosis especially in subjects who drink too much alcohol without taking enough food for a long period of time.
The effectiveness and safety of total glucosides of paeony in systemic lupus erythematosus: A systematic review and meta-analysis
Authors: Wang Mengjie , Wang Zhiyuan , Liu Ying , Wang Lei , Wang Xiaomeng , Jiang Ping
Published: December 2022

Background:

To evaluate the efficacy and safety of total glucosides of paeony in the treatment of systemic lupus erythematosus (SLE).

Methods:

From the creation of the database to July 2021, multiple databases were searched for randomized controlled trials of treating SLE with total glucosides of paeony (TGP) combining chemical medicine. After screening, quality evaluation and data extraction, the included studies were analyzed by Revman5.3 software.

Results:

A total of 11 studies were included, including 836 patients (treatment group 417, control group 419). Meta analysis showed that on the basis of routine treatment, TGP could further improve the treatment effective rate (OR = 4.19, 95% CI: 2.21 to 7.95, Z = 4.38, P < .0001), reduced SLE Disease Activity Index (SLEDAI) (MD = −1.70, 95%CI: −2.51 to −0.89, Z = 4.11, P < .0001) and erythrocyte sedimentation rate (MD = −7.04, 95%CI: −8.48 to −5.59, Z = 9.53, P < .00001), reduced the level of immunoglobulin A (IgA) (MD = −0.60, 95%CI: −0.82 to −0.37, Z = 5.24, P < .00001), immunoglobulin G (IgG) (MD = −2.97, 95%CI: −3.72 to −2.23, Z = 7.82, P < .00001), and immunoglobulin M (IgM) (MD = −0.36, 95%CI: −0.45 to −0.27, Z = 7.54, P < .00001), increased the level of complement C3 (MD = 0.34, 95%CI: 0.30 to 0.39, Z = 14.40, P < .00001) and complement C4 (MD = 0.07, 95%CI: 0.06 to 0.08, Z = 10.08, P < .00001), and decreased the recurrence (OR = 0.31, 95%CI: 0.16 to 0.61, Z = 3.39, P = .0007), and there was no significant difference in the incidence of adverse reactions (OR = 0.93, 95%CI: 0.45 to 1.91, Z = 0.20, P = .84).

Conclusion:

On the basis of conventional treatment, the combined use of TGP can enhance the clinical efficacy of SLE without increasing the incidence of adverse effects.
The pandemic’s effect on a patient cohort with painful polyneuropathy in 2020: A longitudinal study on pain, mood, and everyday life
Authors: Kersebaum Dilara , Sendel Manon , Fabig Sophie-Charlotte , Sachau Juliane , Lassen Josephine , Rehm Stefanie , Forstenpointner Julia , Rümenapp Johanna , Vollert Jan , Hüllemann Philipp , Baron Ralf , Gierthmühlen Janne
Published: December 2022

In the early phase of the COVID pandemic 2020, we demonstrated how patients with painful polyneuropathy, against our expectations, did not experience a deterioration of their neuropathic pain. We hypothesized that our assessed measures, that is, pain intensity and characteristics, emotional wellbeing, and everyday life, would deteriorate in the further course of the pandemic according to the phases of disaster management. Thus, the aim of our study was to investigate patients repeatedly under varying pandemic conditions from March until December 2020. Sixty-three patients were investigated with validated questionnaires (brief pain inventory [BPI], neuropathic pain symptom inventory [NPSI], pain catastrophizing scale [PCS], patient-reported outcomes measurement information system [PROMIS] pain interference/sleep disturbance/fatigue/ depression/anxiety, EuroQol 5 dimensions 5 level version [EQ-5D-5L]) and a pandemic-specific, self-designed questionnaire. The data from the beginning of the pandemic with severe restrictions, during summer with loosened regulations and from December 2020 with reinstalled, severe restrictions were compared with an observational design. Patients reported higher pain severity when restrictions were lower. Sleep, mood, and quality of life did not change in the course of the pandemic in the validated measures. Pain interference significantly decreased during the study independent from restrictions. Patients who reported medical disadvantages had a lower quality of life upon EuroQol 5 dimension (EQ-5D) and were significantly more worried about their health. The perception of pain intensity was dependent on pandemic severity. Sleep, mood, and quality of life did not change significantly in validated measures. Continued medical care seems decisive to prevent worsening of pain and quality of life.
Dosimetric comparison of fixed field dynamic IMRT and VMAT techniques in simultaneous integrated boost radiotherapy of prostate cancer
Authors: Sun Haitao , Wang Ning , Huang Guosen , Liu Xiangping
Published: December 2022

High-risk prostate cancer can take advantage of the combination of hypofractionated radiotherapy and pelvic conventional fraction radiotherapy. The comparison between fixed field dynamic IMRT and VMAT techniques can provide suggestions for clinical treatment. We selected 10 high-risk prostate cancer patients who received radiotherapy at the cancer center of Sun Yat-sen University from January 2016 to December 2019. The targets contained in prostate, seminal vesicles and pelvic lymph nodes. With the same prescription and optimized parameters, 9F, single-arc (1ARC) and double-arc (2ARC) treatment plans were developed. The dose distribution of the targets, OAR, MU, treatment time and gamma pass ratios of dose verification was compared. The D2% (69.37 ± 0.89) Gy, D50% (66.92 ± 0.63) Gy, HI (0.09 ± 0.02), and CI (0.83 ± 0.05) of PTV1 in 9F were slightly better than those of 1ARC which were (71.13 ± 1.21) Gy, (68.50 ± 0.76) Gy, (0.12 ± 0.02), (0.74 ± 0.07), except D98%, the difference was significant (P < .05). All dosimetry indices of PTV1 in 9F and 2ARC were close and have no significant differences (P > .05). The V95% (99.45 ± 0.78)% of PTV2 in 9F was slightly better than that in 1ARC (99.35 ± 1.28)%. The difference was significant (P < .05). All dosimetry indices of PTV2 in 9F and 2ARC were close and the difference was not significant (P > .05). The Dmean of the bladder and the V67.5 Gy of rectum between all three plans were similar. The Dmean of left and right femoral in 1ARC and 2ARC were lower than that in 9F, and the difference was significant (P < .05). Other dosimetry indices of OARs in 9F were lower than those in 1ARC and 2ARC, and much lower than 1ARC. The difference was significant (P < .05). Mean monitor units in 1ARC and 2ARC were fewer by 70.0% and 67.2% in comparison with 9F. The treatment mean time in 1ARC and 2ARC was shorter by 81.7% and 61% in comparison with 9F. Verification pass ratios of γ (3%/3 mm) were 97.8% (9F), 98.9% (1ARC) and 99.4% (2ARC) respectively. The difference was significant (P < .05). Compared with IMRT, VMAT improved delivery efficiency noticeably. Two arcs provided comparable tumor dosimetry coverage, but performed worse in dose sparing for bladder, rectum and small bowel. The IMRT plan was preferable to VMAT in prostate cancer simultaneous integrated boost radiotherapy.
A five ferroptosis-related genes risk score for prognostic prediction of osteosarcoma
Authors: Ge Zhanyong , Song Delei
Published: December 2022

Background:

Osteosarcoma (OS) is the most common bone cancer in adolescents, and has a high propensity to metastasize. Ferroptosis is a unique modality of cell death, driving the metastasis of cancer cells. Identifying ferroptosis-related genes (FRGs) as prognostic factors will be critical to predict the outcomes of OS. This study aimed to explore the prognostic value of FRGs in OS and build a prognostic model to indirectly improve OS patients’ outcomes.

Methods:

OS data were downloaded from the TARGET database and 2 Gene Expression Omnibus datasets. Univariate Cox regression was conducted to assess FRGs. A risk score model basing on 5 FRGs was constructed via LASSO-Cox regression. Multivariate Cox regression analysis was used to determine the independent prognostic factors. The Nomogram model was built using independent prognostic factors. The relationship between the risk score and the immune cell infiltration was estimated by CIBERSORT, and the correlation between the risk score and immune checkpoints was also analyzed.

Results:

Based on the prognosis-related FRGs, we built a regression model: Risk score = (−0.01382853 × ACSL4) − (0.05371778 × HMOX1) − (0.02434655 × GPX4) − (0.16432810 × PRNP) − (0.15567120 × ATG7). OS patients with high risk score tended to suffer from poor prognosis, validated in 2 Gene Expression Omnibus datasets. The Nomogram model showed the combination of the risk score and the tumour-node-metastasis stage improved predictive effectiveness. The risk score was also related to immune cell infiltration and immune checkpoint expression.

Conclusion:

The risk score model based on 5 FRGs was a reliable prognostic predictive indicator for OS patients.
Endoscopic submucosal dissection for papillary early gastric carcinoma: Insights from a large-scale analysis of post-gastrectomy pathology specimens
Authors: Lee Jung Hwan , Oh Ju Yeon , Kim Young-Il , Lee Jong Yeul , Kim Chan Gyoo , Choi Il Ju , Ryu Keun Won , Kim Young-Woo , Cho Soo-Jeong
Published: December 2022

Gastric papillary adenocarcinoma is considered a differentiated adenocarcinoma in the current endoscopic submucosal dissection indication guidelines. However, the safety of endoscopic submucosal dissection remains controversial. Currently, data regarding which papillary early gastric cancer should be considered for endoscopic submucosal dissection are unavailable. Thus, the aim of this study was to investigate lymph node metastasis and the safety of endoscopic submucosal dissection in patients with papillary early gastric cancer. This observational study recruited 4264 consecutive patients with early gastric cancer who underwent curative gastrectomy between October 2000 and December 2017 at the National Cancer Center, Korea. Of these, 45 had pathologically confirmed papillary early gastric cancer, 2106 had differentiated non-papillary early gastric cancer, and 2113 had undifferentiated early gastric cancer. Logistic regression analysis was performed to identify risk factors for lymph node metastasis. Mucosal tumors were less common in papillary early gastric cancer (37.9%) than in differentiated non-papillary early gastric cancer (48.8%) and undifferentiated early gastric cancer (60.4%) (both P < .001). Lymph node metastasis was more common in papillary early gastric cancer (20.0%) than in differentiated non-papillary early gastric cancer (9.2%) and undifferentiated early gastric cancer (11.7%; both P < .001). In multivariate analysis, non-mixed-type papillary early gastric cancer showed marginally increased odds of lymph node metastasis than differentiated early gastric cancer (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.0–6.3). Rates of lymph node metastasis (1/10, 10%) and angiolymphatic invasion (2/10, 20%) for papillary early gastric cancer meeting expanded criteria were higher than those for other histology types meeting endoscopic submucosal dissection absolute or expanded criteria (P = .03 and P < .001, respectively). Endoscopic submucosal dissection should be considered carefully for papillary early gastric cancer, especially if it meets expanded endoscopic submucosal dissection indications since it is associated with high rates of submucosal invasion and lymph node metastasis.
Acute burn care and outcomes at the Hospital Nacional Guido Valadares (HNGV), Timor-Leste: A 7-year retrospective study
Authors: Salendo Junius , Ximenes Joao , Soares Alito , Guest Glenn , Hagander Lars
Published: December 2022

The purpose of this study was to describe the epidemiology of patients presenting with acute burns and undergoing admission at Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste in the period 2013 to 2019. HNGV is the only tertiary referral hospital in Timor-Leste. This was a retrospective study involving all acute burn patients admitted to the surgical wards of HNGV from 2013 to 2019. The data was collected from patient charts and hospital medical archives. Data were reviewed and analyzed statistically in terms of age, gender, residence, cause, total body surface area (TBSA), burns depth, length of stay (LOS), and mortality. The outcomes were analyzed using logistic regression. Over the 7-year period, there were 288 acute burn patients admitted to the surgical wards of HNGV. Most patients were children (55%), male (65%) and from the capital city of Dili or surrounding areas (59%). The most common cause of burns in children was scalds and the most common cause among adults was flames. Of the admitted patients 59% had burns affecting >10% of the TBSA and 41% had full thickness burns. The median LOS was 17 days (1–143) and the average mortality for admitted burn patients in HNGV was 5.6% (annual mortality 0–17%). The odds ratio for extended LOS was 1.9 (95% confidence interval 1.1–3.2) in female compared with male patients. The odds ratio for mortality was 14.6 (95% confidence interval 2.7–80.6) in the older adults when compared with younger adults. Higher TBSA, full thickness burns, and flame burns were also significantly associated with longer LOS and higher mortality. Children and male patients were disproportionately overrepresented among patients admitted to HNGV, while female patients had longer LOS and older adults had more severe injury and a higher risk of mortality. Establishment of a national program for the prevention of burns is essential.
Elevated serum uric acid is not an independent risk factor for the occurrence of Type 2 diabetic kidney disease in Chinese populations
Authors: Zhu Lin , Sun Jiaxing , Wang Xuening , Tian Ruina , Zhou Yuexin , Yu Jiangyi , An Xiaofei
Published: December 2022

Previous studies suggested that increased serum uric acid (SUA) level is an independent risk factor for albuminuria in Type 2 diabetes (T2D) patients. However, the association between SUA and onset of Type 2 DKD (T2DKD) remained to be clarified. This was a cross-sectional clinical study in which 1210 Chinese T2D patients were enrolled. According to the urine albumin-to-creatinine ratio (UACR), the cohort was divided into normal-albuminuria (UACR < 30 mg/g), micro-albuminuria (UACR 30–300 mg/g) and macro-albuminuria (UACR > 300 mg/g). The micro- and macro-albuminuria groups were combined into albuminuria category. Results showed that T2D patients with macro-albuminuria have significantly higher SUA than the other 2 groups (P < .001). In the binary logistic regression model, the subjects with SUA higher than 420 μmol/L were associated with a 2-fold increase in the odds of albuminuria (odds ratio = 2.024, 95% confidence interval: 1.232–3.325, P = .005), as compared with those with SUA lower than 300 μmol/L. Moreover, the multinomial regression analysis revealed that the subjects with SUA higher than 420 μmol/L had about 3-fold increase in the odds of macro-albuminuria (odds ratio = 3.758, 95% confidence interval: 2.051–6.885, P < .001), as compared with those with SUA lower than 300 μmol/L. However, SUA was not significantly associated with the presence of micro-albuminuria. Although the SUAwas not independently risk factor for micro-albuminuria, it was closely correlated with the development of macro-albuminuria in Chinese T2DKD patients. Elevated SUA may be useful for predicting the occurrence of macro-albuminuria but not onset of micro-albuminuria at the early stage of T2DKD.
Humoral response to vaccination against SARS-CoV-2 in patients undergoing dialysis
Authors: Lee Yoo Jin , Park Bong Soo , Heo Chang Min , Park Sihyung , Yu Shinae , Kim Yang Wook
Published: December 2022

Patients undergoing maintenance dialysis have a higher mortality rate associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and response rates to vaccination against SARS-CoV-2 vary from 29.6% to 96.4% in such patients. This study aimed to assess the immunogenicity of SARS-CoV-2 vaccination in Korean patients undergoing dialysis. We enrolled 70 SARS-CoV-2-vaccinated patients undergoing dialysis, with 11 healthcare workers serving as healthy control subjects. Thirty-two patients had received a third vaccination, whereas 38 had received 2 vaccinations. The healthy control subjects completed the second vaccination. Immunoglobulin G (IgG) antibodies targeting the receptor-binding domain of the S1 subunit of the SARS-CoV-2 spike protein were measured The vaccination responder rates were 86% (37/43), 96% (26/27), and 91% (10/11) in the patients undergoing hemodialysis and peritoneal dialysis and healthy controls, respectively. IgG antibody levels were significantly higher when a third dose was administered, independent of the type of vaccine or the time interval between vaccination and the subsequent blood sampling date. When a third dose of vaccine was administered, there was no difference in IgG antibody levels between those receiving cross-vaccination or a single vaccine. There was no significant difference in IgG antibodies between healthy controls and patients undergoing dialysis. Patients on dialysis exhibited a sufficient antibody-related response to vaccination against SARS-CoV-2, even in those receiving cross-vaccination, and the antibody titer was higher after a third vaccination. Therefore, it is necessary to administer a third vaccine dose to Korean patients undergoing dialysis.
Efficacy and safety of Kanglaite plus EGFR-TKI in the treatment of advanced non-small cell lung cancer: A meta-analysis of 13 RCTs
Authors: Li Dailong , Li Wanqiang , Xu Lu , Che Yuan , Cheng Chunlai
Published: December 2022

Background:

Kanglaite (KLT) is a Chinese medicine antitumor drug independently developed in China, which has been widely used in the treatment of advanced non-small cell lung cancer (NSCLC). The purpose of this study was to systematically evaluate the efficacy and safety of KLT plus epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in the treatment of advanced NSCLC.

Methods:

Up to September 1, 2022, the databases of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal, and Wanfang were searched, and the randomized controlled clinical trials (RCTs) of KLT plus EGFR-TKI in the treatment of advanced NSCLC were included. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included literature. Revman5.4 software was used for meta-analysis.

Results:

A total of 1057 patients were included in 13 RCTs. The results of meta-analysis showed that KLT plus EGFR-TKI could improve the objective response rate (ORR) (risk ratio (RR) confidence interval (CI) [RR = 1.54, 95% CI: 1.27–1.86, P < .00001]), the disease control rate (DCR) (RR = 1.23, 95% CI: 1.14–1.32, P < .00001), and quality of life (QOL) (RR = 1.79, 95% CI: 1.36–2.36, P < .0001) in patients with advanced NSCLC. The percentages of CD3+T cells (standardized mean difference [SMD = 2.37, 95% CI: 0.80–3.93, P = .003]), CD4+T cells (SMD = 1.39, 95% CI: 0.85–1.93, P < .00001), NK cells (SMD = 1.59, 95% CI: 0.88–2.30, P < .0001), and CD4+/CD8+ratio (SMD = 0.37, 95% CI: 0.19–0.55, P < .0001) were also increased. However, the results of subgroup analysis showed that in patients with EGFR mutation NSCLC, compared with EGFR-TKI alone, KLT plus EGFR-TKI did not significantly increase ORR and DCR (RR = 1.43, 95% CI: 0.88–2.32, P = .15; RR = 1.07, 95% CI: 0.96–1.20, P = .21). In terms of adverse events of drugs, the incidence of diarrhea, rash, anorexia, nausea and vomiting, liver and renal function damage of KLT plus EGFR–TKI was similar to that of EGFR-TKI alone (P > .05).

Conclusion:

KLT plus EGFR-TKI has some clinical benefits and good safety compared with EGFR-TKI alone in the treatment of advanced NSCLC. However, it seems that patients with EGFR mutations do not get significant clinical benefits, and more high-quality RCTs are needed to prove the efficacy of the combined regimen.
Significant improvement of procedural safety in stenting for basilar stenosis: A historically controlled study
Authors: Wang Kai , Xu Xiao-tong , Jin Min , Liu Ao-fei , Guo Bao-shi , Qu Ming-yue , Gao Feng , Xiang Li , Liu Yun-e , Man Feng-yuan , Jiang Wei-jian
Published: December 2022

The basilar artery has the most perioperative complications in stenting compared to the other intracranial arteries. We aim to study whether the procedural safety in stenting for basilar stenosis has improved. This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. Between January 2012 and March 2019, 147 consecutive patients with symptomatic basilar stenoses receiving elective stenting treatment were included in current basilar artery stenting (BAS) group. The prospectively collected and registered 120 patients by the same interventional team from September 2001 to November 2011 were set as historical BAS group for control. A total of 267 individuals were included in this study, with a mean age of 59.5 ± 8.1 years. The proportion of patients with lesion length >15 mm was 26.5% (39/147) in the current BAS group versus 4.2% (5/120) in the historical BAS group. We found significant differences between these 2 groups in Mori A (17.7% vs 42.5%) and Mori C patients (42.9% vs 13.3%). The proportion of patients receiving preoperative high-resolution magnetic resonance (HRMRI) evaluation was 83.0% (122/147) in the current BAS group versus 20.8% (25/120) in the historical group (P < .05). Balloon-expendable stent (BES) (n = 1), Wingspan (n = 34), and Enterprise (n = 112) stents were placed in the current BAS group. In contrast, only balloon-expendable stent (BES) (n = 48) and Wingspan (n = 72) were deployed in the historical BAS group. The incidence of the safety endpoint (SE) was 4.1% (involving 6 patients) in the current BAS group versus 11.7% (involving 14 patients) in the historical BAS group (P < .05). In multivariate analysis, no risk factor was associated with the occurrence of the safety endpoint (SE). When BAS cases operated by the surgical team accumulated to 120 to 150, the incidence of complications decreased significantly. This is the largest sample size study to discuss the safety of BAS. The significantly decreased incidence of complications indicates that the improving technical measures and the accumulation of operation experience are necessary.
Solitary fibrous tumor of male breast: A case report and literature review
Authors: Kawaguchi Shun , Kinowaki Keiichi , Tamura Nobuko , Nishikawa Aya , Shibata Akio , Tanaka Kiyo , Kobayashi Yoko , Ogura Takuya , Sato Junichiro , Kawabata Hidetaka
Published: December 2022

Background:

Solitary fibrous tumors (SFT) are uncommon mesenchymal neoplasms which can arise in any anatomical location. Pleural SFTs have been most frequently documented; however, breast SFT is an exceedingly rare entity and seldom present in male breast, with only 8 previously reported cases. Recently, STAT6 immunostaining was considered to be a definitive marker of SFT, however, no case of the male breast SFT showing STAT6 positivity preoperatively has been reported.

Methods and Results:

We describe a case of breast SFT in a 73-year-old male patient with a 12-month history of a palpable breast mass. The only associated clinical symptom was bilateral gynecomastia. An ultrasound scan examination revealed an oval, well-circumscribed and hypoechoic mass with hypervascularity. A core-needle biopsy was performed, and microscopic examination with immunohistochemistry confirmed the diagnosis of SFT. He underwent a complete surgical resection with clear margins, and there were no signs of high cellularity, remarkable mitotic activity, pleomorphism, hemorrhage or necrosis.

Conclusion:

A perioperative immunohistochemical evaluation for diffuse and intense nuclear expression of STAT6 was helpful to distinguish SFT from myofibroblastoma. We, herein, describe the first case of SFT in a male breast, confirmed by STAT6 immunostaining positivity. We also conducted a literature review of all previous cases of breast SFTs.
Dysentery and leg ulcer as an atypical presentation of systemic lupus erythematosus: A case report
Authors: Sah Biki Kumar , Chaudhary Shipra , Pahari Ashhrik , Ghimire Aasha , Sah Rajan Kumar , Sah Abhishek Kumar , Kumari Neelam , Jaiswal Yaswant Kumar , Sah Vivek Kumar
Published: December 2022

Introduction:

Due to heterogeneity in the organs involved and a variety of influencing factors, a wide range of clinical manifestations are possible in systemic lupus erythematosus (SLE). In our knowledge, a combination of leg ulcer and dysentery as presenting symptoms of SLE has never been reported previously.

Patient concerns:

A 13-year-old female child presented with a chronic wound over right medial malleolus for 6 months, and passing of watery stool, later mixed with blood, for 4 days. On examination, she had a fever of 38.5°C. Lab reports revealed anemia, thrombocytopenia, proteinuria, and features of urinary tract infection. Renal biopsy showed membranous glomerulonephropathy. She was positive for antinuclear antibodies (ANA) and antidouble stranded DNA (anti-dsDNA). Immunofluorescence revealed reduced C4 and C3 levels. Abdominal ultrasound showed symmetrical circumscribed thickening, and edematous cecum and ascending colon.

Diagnosis:

The patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics classification criteria.

Interventions:

The patient was treated with prednisolone, hydroxychloroquine, metronidazole, ciprofloxacin, trypsin-chymotrypsin, zinc, calcium, and calcitriol tablets.

Outcomes:

Fever subsided within 3 days of treatment. Gastrointestinal symptoms subsided within 1 week of treatment. On 31 day of treatment, the wound had been reduced and showed features of healing.

Conclusion:

Dysentery and leg ulcers can be the manifestations of SLE. Therefore, SLE should also be considered when a patient presents with such symptoms. Any suspicion of infection in SLE should be treated aggressively with antibiotics.
One-stage anterior focus debridement, interbody bone graft, and anterior instrumentation and fusion in the treatment of short segment TB
Authors: Lu Zenghui , Ding Chao , Wei Lin , Zhang Huijun
Published: December 2022

To evaluate the clinical efficacy of 1-stage anterior focus debridement, interbody bone graft, and anterior instrumentation and fusion in the treatment of short segment thoracic tuberculosis with paraplegia or incomplete paralysis. A total of 16 adult patients with short segment thoracic spinal thoracic tuberculosis who underwent surgery were enrolled in this retrospective study. All patients received anterior focus debridement, interbody bone graft and anterior instrumentation and fusion. All patients were followed up for 24 to 48 months. Clinical manifestations, laboratory examinations, neurological symptoms, bone fusion and imaging results were analyzed. All patients successfully underwent operations. The symptoms of chest and back pain were alleviated and even disappeared during postoperative 1 to 6 months. There was no recurrence. All patients got bony spinal fusion within postoperative 4 to 8 months assessed by spinal X-ray film. The levels of erythrocyte sedimentation rate and C-reactive protein were significantly decreased from 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L to 15.9 ± 4.6mm/h and 4.7 ± 2.0mg/L at the final follow-up, respectively (P < .05). The thoracic kyphosis angle was also notably decreased from 15.0 ± 3.4° to 9.1 ± 1.9° after operation(P < .05). During the follow-up, the symptom of paraplegia or incomplete paralysis was significantly improved. Neurologic status in all patients was also improved to some extent. The combination of 1-stage anterior focus debridement, interbody bone graft and anterior instrumentation and fusion is an effective and feasible treatment method for short segmental thoracic tuberculosis with paraplegia or incomplete paralysis.
Electroacupuncture for postoperative pain in mixed hemorrhoids: A meta-analysis
Authors: Du Binglin , Xu Zhongmiao , Zhong Xin
Published: December 2022

Background:

To investigate the efficacy of electroacupuncture for postoperative pain in mixed hemorrhoids.

Methods:

Randomized controlled trials were searched in PubMed and Cochrane Library. The risk of bias assessment tool was used to assess methodological quality. Stata 14.0 software was used for meta-analysis. Weighted mean differences were calculated if all outcome variables were reported the same way, while standardized mean differences (SMD) were calculated if they were different.

Results:

From 27 identified studies, 5 Chinese studies (465 patients) were included in this meta-analysis. The electroacupuncture group had significantly lower postoperative pain scores compared with the control group at 6 hours postoperatively (SMD = –0.89, 95% CI: –1.091 to –0.692; P < .001), at 12 hours postoperatively (SMD = –1.089, 95% CI: –1.336 to –0.843; P < .001), at 24 hours postoperatively (SMD = –0.548, 95% CI: –0.721 to –0.374; P = .547), and 72 hours postoperatively (SMD = –1.089, 95% CI: –1.336 to –0.843; P < .001).

Conclusion:

Electroacupuncture can improve pain after surgery for mixed hemorrhoids. It is an effective method to improve the pain after hemorrhoidectomy, which deserves further research and promotion.
Efficacy and safety of fire needle combined with cupping for acute herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis
Authors: Huang Shijie , Xu Yipeng , Pan Zhengqi , Li Zimeng , Luo Rui , Yu Maogui , Li Wuyu , Liu Hanghang , Wu Jie
Published: December 2022

Background:

Herpes zoster and post-herpetic neuralgia showed an increasing incidence during past two decades. Most of herpes zoster and post-herpetic neuralgia patients suffered from pain, anxiety, and depression. Fire needle combined with cupping is becoming a popular way to relieve the pain caused by herpes zoster and decrease the incidence of post-herpetic neuralgia. In this study, we aim to investigating the efficacy and safety of fire needle combined with cupping for the treatment of acute herpes zoster and postherpetic neuralgia (PHN).

Methods:

The literature search will be carried out in following databases: PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data. Published and unpublished controlled trials compared fire needle combined with cupping to other treatments for acute herpes zoster or PHN will be included. Data from eligible studies will be extracted by 2 independent reviewers. Different scales will be used to assess the risk of bias based on the study design. Pain intensity and PHN are primary outcomes. The final effect size will be reported using 95% confidence interval at 0.05 significance level.

Discussion:

This review will provide certain evidence to compare the efficacy and safety of combined acupuncture and cupping with guideline recommended drug or nerve block therapy for the treatment of herpes zoster and post-herpetic neuralgia. It will potentially provide more clinical suggestions and guidelines for health care professionals, policymakers, and researchers.
Utility of the gastro-laryngeal tube during transesophageal echocardiography: A prospective randomized clinical trial
Authors: Calim Muhittin , Uysal Harun , Kahraman Ay Nuray , Karaaslan Kazim , Daskaya Hayrettin
Published: December 2022

Background:

To validate the utility and performance of the gastro-laryngeal tube (GLT) in terms of cardiologist and patient satisfaction levels, incidence of and attempts at successful transesophageal echocardiography (TEE) probe placement, perioperative and postoperative hemodynamics, and adverse events related to the TEE procedure.

Methods:

In this randomized prospective clinical study, forty-four patients undergoing TEE and aged 20 to 80 years old scheduled for TEE were randomly allocated to two study groups: Group SA (sedation and analgesia) and Group GLT. Cardiologist and patient satisfaction levels, TEE probe placement performance, hemodynamics, adverse events related to the TEE procedure, demographic characteristics, and TEE procedure data were recorded.

Results:

The cardiologist satisfaction level was significantly higher in Group GLT (P = .011). The TEE probe was successfully placed at the first attempt in all the patients in Group GLT and at the first attempt in 11 patients, at the second attempt in 8 patients, and at the third attempt in 3 patients in Group SA. The TEE probe placement success was significantly higher in Group GLT (P < .001), and TEE probe placement was significantly easier in Group GLT (P < .001). There were no significant differences in patient satisfaction, heart rate, mean arterial pressure, oxygen saturation, adverse events related to the TEE procedure between the groups.

Conclusion:

The present study revealed that GLT use elicited a higher cardiologist satisfaction level and resulted in more successful and easier TEE probe placement. We thus conclude that the use of the recently developed GLT may ensure airway management safety and a comfortable TEE experience.
Surgical Pitfalls in Bertolotti’s syndrome management: A case report
Authors: Afana Hatem , Raffat Muhammad , Figueiredo Nicandro
Published: December 2022

Rationale:

Bertolotti’s syndrome is one of the differential causes of low back pain, especially within young people. The etiopathogenesis of the typical paramedian low back pain, associated with Bertolotti’s syndrome remains controversial, and there is no worldwide acceptance of treatment.

Patient concerns:

This article presents the authors experience with surgical treatment of symptomatic patients with Bertolotti’s syndrome.

Diagnoses:

Retrospective study of a selected series of patients with symptomatic Bertolotti’s syndrome submitted to surgical treatment.

Interventions:

This study included 16 patients, being 8 submitted to the new modified mini-open tubular microsurgical transverse processectomy, Among those patients, intraoperative fluoroscopy was used in 6 surgeries to locate the base of the enlarged transverse process (6/8); intraoperative neuromonitoring was used in 6 patients (6/8), 3D intraoperative advanced spinal image (O-arm) with neuronavigation was used to localize the base of the pseudojoint to be removed and to check the final bone resection for the last 5 cases (5/8).

Outcomes:

The average paramedian lower back pain before surgery on the visual analogue scale for pain in the 8 patients was 6.6 (range: 5–8) and reduced to 1.5 (range: 0–3) at the latest follow-up after surgery, while the average pain score of the radicular pain on the right or left side before the surgery was 1.3 (range: 0–6) and reduced to 0.6 (range: 0–7) after the surgery.

Lessons:

The mini-open tubular microsurgical transverse processectomy seems to be potentially safe and effective for the surgical treatment of selected symptomatic patients with Bertolotti’s syndrome.
Health-care provider burnout in Syria during COVID-19 pandemic’s Omicron wave
Authors: Swed Sarya , Bohsas Haidara , Alibrahim Hidar , Hafez Wael , Shoib Shiekh , Sawaf Bisher , Rais Mohammed Amir , Aljabali Ahmed , Shaheen Nour , Elsayed Mohamed , Rakab Amine
Published: December 2022

Health-care workers (HCWs) have dealt with various psychological problems during the COVID-19 epidemic, including sadness, mental discomfort, anxiety, and poor sleep. Burnout is a state of prolonged work-related psychological, emotional, and physical stress brought on by emotional weariness, depersonalization, and decreased professional success. This study aimed to determine how many HCWs burned out during the Omicron wave of the COVID-19 pandemic and determine what factors put them at risk for this psychological effect. This cross-sectional research was performed in Syria during the current Omicron wave of the COVID-19 pandemic to evaluate the burnout experienced by Syrian physicians who treat COVID-19 patients. The inclusion criteria were all Syrian HCWs who treated COVID-19 patients during the current Omicron wave of COVID-19. The data was collected between April 3 and March 20, 2022. We investigated whether the questionnaire used was valid and understandable to the participants. A total of 729 health-care providers were inquired in our study; however, 30 participants were disqualified because their answers were not fully completed. The overall age of the participants was 31 ± 9, and the ratio of males to females was almost equal. The majority (47.5%) of the sample study’s participants are residents, and 72.8% who cared for COVID-19 patients. The prevalence of high levels of burnout in the sample study was 41.6%. Compared to men (22.3%), women were much more likely (27.9%) to report experiencing a high degree of emotional exhaustion; also, the participants who cared for COVID-19 patients were much more likely (30.1%) to report experiencing a high degree of emotional exhaustion compared to others, which individuals who cared for COVID19 patients were 1.76 times more likely than participants who did not care for COVID19 patients to experience severe burnout (odds ratio: 1.766, 95% confidence interval:1.2–2.4, P value < .001). Our research found severe burnout among Syrian health-care providers during the omicron wave of COVID-19, with clinicians caring for COVID-19 patients being considerably more likely to express high burnout than others.
Efficacy and safety of PD-1/PD-L1 immune checkpoint inhibitors in treating non-Hodgkin lymphoma: A systematic review and meta-analysis of clinical trials
Authors: Guan Jiaheng , Zhang Jing , Zhang Xiaoping , Yuan Zhongshu , Cheng Jian , Chen Baoan
Published: December 2022

Background:

Immunotherapy with programmed cell death protein-1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors has been widely used in the treatment of solid tumors and Hodgkin lymphoma, demonstrating powerful efficacy and good safety. However, there is no systematic review and meta-analysis to fully investigate the efficacy and safety of PD-1/PD-L1 inhibitors in treating non-Hodgkin lymphoma (NHL).

Methods:

We searched PubMed, EMBASE, The Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and abstracts of conference proceedings of annual meetings up to January 23, 2022, to identify eligible clinical trials. To evaluate the efficacy of PD-1/PD-L1 inhibitors, objective response rate (ORR), complete response rate (CRR), 1-year overall survival rate, and 1-year progression-free survival rate were analyzed. For safety analysis, we calculated rates of any grade and grade ≥3 treatment-related adverse events.

Results:

Overall 22 studies and 1150 participants were enrolled in this meta-analysis. The pooled ORR, CRR, 1-year overall survival, and 1-year progression-free survival rates were 0.43 (95% confidence interval [CI], 0.33–0.54), 0.21 (95% CI, 0.13–0.31), 0.72 (95% CI, 0.58–0.89), and 0.42 (95% CI, 0.29–0.62), respectively. The ORR and CRR in the combination immunochemotherapy subgroup (0.65 and 0.41) were higher than those in the monotherapy (0.27 and 0.09) and combination chemotherapy (0.39 and 0.19) subgroups. This study was registered with PROSPERO (#CRD 42022316805).

Conclusion:

Given that there were limited clinical trials and relatively few relevant studies, we conducted this meta-analysis to fully elucidate the efficacy and safety of PD-1/PD-L1 inhibitors in NHL. Our results suggested that PD-1/PD-L1 inhibitors improved outcomes of responses as well as survival rates in NHL patients with tolerable adverse events. More well-designed randomized clinical trials are still needed to further confirm our findings.
Impact of soft tissue around the knee on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis
Authors: Liu Yu , Wu Chunhu , Chen Changsong , Zhang Lianhe , Xing Gengyan , Wu Kun , Zhao Zhe , Yin Huadong , Ma Yuhai
Published: December 2022

Knee osteoarthritis (KOA) is the leading cause of knee pain in middle-aged and older individuals. Extracorporeal shockwave therapy (ESWT) has been applied to treat patients with KOA to reduce pain and improve function. Patients (n = 123) diagnosed with KOA who received ESWT were selected to participate in this study, and were grouped according to their body mass index (BMI). The treatment parameters were as follows: 8000 pulses, 2.0 bar, 0.25 mJ/mm2, and 6 Hz/s once per week for 8 weeks. The visual analog scale (VAS), Lequesne index, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were measured to assess knee pain and functional recovery according to BMI groups. Radiographs were used to measure the richness of the soft tissue around the knee joint. The correlation between the distribution of tissue, pain, and functional improvement was analyzed using the receiver operator characteristic curve. All the patients showed a reduction in pain after treatment compared to that before treatment (P < .01). As measured by the VAS, the Lequesne and WOMAC indexes, after the intervention, the pain and functional index of the overweight and above BMI group improved to a greater extent than that of the normal or below normal BMI group (P < .01). The area under the curve showed, with VAS as the demarcation criterion, when the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio exceeded 1.538, 1.534, and 1.296, respectively, the patient’s pain relief was more pronounced the ESWT treatment was better. With pain in WOMAC as the demarcation criterion, the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio also are positively correlated with pain relief in patients. When the Lequesne and WOMAC scores were the demarcation criteria, the patients’ function improved significantly when the patella apical soft tissue ratio exceeded 2.401 and 2.635, respectively. ESWT can effectively alleviate pain and improve knee function in patients with KOA, and the soft tissue around the knee joint should also be an important reference factor in KOA treatment.
Risk factors and long-term prognosis for postoperative hypoxemia in patients with acute type A aortic dissection: A retrospective observational study
Authors: Song Xiao-Chun , Nie Shuai , Xiao Ji-Lai , Shen Xiao , Hong Liang , Chen Shang-Yu , Zhang Cui , Mu Xin-Wei
Published: December 2022

Hypoxemia is 1 of the most common complications in the patients with acute Type A aortic dissection (ATAAD). This study aimed to summarize the risk factors, management strategies and long-term prognosis for postoperative hypoxemia in ATAAD patients. Baseline characteristics and clinical data of all the patients were collected. Patients were divided into 2 groups according to the PaO2/FiO2 after surgery: Hypoxemia group (n = 142) and Non-hypoxemia group (n = 68). The differences in gender, age, body mass index, operation time, cardiopulmonary bypass (CPB) time, aortic cross-clamping time, deep hypothermic circulatory arrest time, preoperative PaO2/FiO2, postoperative PaO2/FiO2, PaO2/FiO2 before extubating, time of mechanical ventilation, length of intensive care unit stay, length of hospital stay, in-hospital mortality, and overall mortality were compared between the 2 groups. The incidence of postoperative hypoxemia in this study was 67.6% (142/210). body mass index (26.4 ± 3.8 vs 24.4 ± 3.3kg/m2, P < .001) in the hypoxemia group were markedly higher and CPB time (196.3 ± 41.0 vs 181.0 ± 37.3 minutes, P = .010) in the hypoxemia group were significantly longer than those in the non-hypoxemia group. While preoperative PaO2/FiO2 (229.7 ± 91.4 vs 299.7 ± 101.2mmHg, P < .001) was significantly lower than those in the non-hypoxemia group. In the hypoxemia group, PaO2/FiO2 before extubating was significantly higher than that after operation, and the difference was significant. Logistic regression analysis showed that overweight (odds ratio [OR]: 1.113, P = .030), CPB time (OR: 1.009, P = .043) and preoperative PaO2/FiO2 (OR: 0.994, P = .001) were independent risk factors for postoperative hypoxemia. Further follow-up results showed no significant difference in long-term mortality between the 2 groups. Logistic regression analysis revealed that PaO2/FiO2 before extubating (OR: 0.985, P < .001), paraplegia (OR: 10.994, P = .019), acute renal failure (OR: 12.590, P < .001), re-operation (OR: 4.721, P = .014) and re-admission to intensive care unit (OR: 13.727, P = .001) were independent risk factors for long-term mortality. Our results showed that overweight and prolonged CPB time were risk factors for postoperative hypoxemia in ATAAD patients. While PaO2/FiO2 before extubating were independent risk factors for long-term mortality, indicating that active correction of hypoxemia and maintain a higher PaO2/FiO2 before extubating may help to improve the prognosis of the ATAAD patients.
Asperosaponin VI induces osteogenic differentiation of human umbilical cord mesenchymal stem cells via the estrogen signaling pathway
Authors: Niu Junting , Wang Yiqing , Meng Yao , Qi Wanli , Wen Jianping
Published: December 2022

Background:

Asperosaponin VI (ASA VI) is an active ingredient found in the traditional Chinese herb Radix Dipsaci, which is used to treat fractures. ASA VI combined with osteogenic medium can induce osteogenic differentiation of rat-derived stem cells. However, whether ASA VI alone can induce osteoblast differentiation of human mesenchymal stem cells (MSCs) remains unclear.

Methods:

ASA VI human-derived binding proteins were searched in the PharmMapper database, osteogenesis-related signaling pathways were obtained through a literature search, and proteins contained in these signaling pathways were queried in the Kyoto Encyclopedia of Genes and Genomes database. SystemsDock was used to perform online molecular docking of target proteins to evaluate their binding abilities, and validation experiments were performed.

Results:

A total of 620 ASA VI target proteins and 12 osteogenesis-related signaling pathways were queried, and 17 intersecting targets were screened. Molecular docking results showed that these targets had high binding affinity for ASA VI. We selected estrogen receptor 2 and its estrogen signaling pathway for experimental validation. The results showed that ASA VI can induce the osteogenic differentiation of MSCs through the estrogen signaling pathway.

Conclusion:

ASA VI can independently induce osteogenic differentiation of human umbilical cord MSCs, and the estrogen signaling pathway plays an important role in this process. Thus, ASA VI may have potential as an anti-osteoporosis drug.