bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive value of baseline C-reactive protein level in patients with stable coronary artery disease: A meta-analysis
Authors: Luo Shuangyan , Zhang Jin , Li Biyan , Wu Hui
Published: September 2022

Background:

Conflicting results have been reported on the association of C-reactive protein (CRP) level with adverse outcomes in patients with stable coronary artery disease (CAD). The objective of this meta-analysis was to evaluate the predictive value of baseline CRP level in stable CAD patients.

Methods:

Two reviewers independently searched PubMed and Embase databases from their inception to November 28, 2021 to identify studies assessing the value of baseline CRP level in predicting adverse outcomes in stable CAD patients. The endpoints of interest included cardiovascular mortality, all-cause mortality, or major adverse cardiovascular events (MACEs). The predictive value of CRP level was estimated by pooling the multivariable adjusted risk ratio with 95% confidence intervals (CI) compared the highest to the lowest CRP level.

Results:

Twenty-six studies involving of 22,602 patients with stable CAD satisfied the inclusion criteria. In a comparison of the highest with the lowest CRP level, the pooled multivariable adjusted risk ratio was 1.77 (95% CI 1.60–1.96) for MACEs, 1.64 (95% CI 1.13–2.33) for cardiovascular mortality, and 1.62 (95% CI 2.62–5.12) for all-cause mortality, respectively. Subgroup analyses indicated that the values of elevated CRP level in predicting MACEs were consistently observed in each subgroup.

Conclusion:

Elevated baseline CRP level was an independent predictor of MACEs, cardiovascular mortality, and all-cause mortality in patients with stable CAD. Baseline CRP level can provide important predictive information in stable CAD patients.
Variability of pulmonary nodule volumetry on coronary CT angiograms
Authors: Pinto Erique , Penha Diana , Hochhegger Bruno , Monaghan Colin , Marchiori Edson , Taborda-Barata Luís , Irion Klaus
Published: September 2022

This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA).

Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules’ diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs.

Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed.

A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([−47.0%; 52.3%]), software packages ([−50.2%; 68.2%]), and observers ([−14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [−13.6%; 31.4%] and [−13.9%; 19.7%], respectively.

Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
Impact of COVID-19 on diagnosis of primary pulmonary coccidioidomycosis
Authors: Ashcherkin Nikita , Gupta Simran , Huff Daniel A. , Vikram Holenarasipur R , Ampel Neil M. , Fischer Karen M. , Blair Janis E.
Published: September 2022

The COVID-19 pandemic has disrupted medical care worldwide and caused delays in care for many illnesses and procedures unrelated to COVID-19; however, less clear is how it may have affected diagnosis of conditions that present with similar symptoms, such as primary pulmonary coccidioidomycosis (PPC). We conducted an observational cohort study of patients diagnosed with PPC between March 1 and December 1 in 2 years: 2019 (before COVID-19) and in 2020 (after COVID-19) to compare the time from symptom onset to PPC diagnosis. Relevant demographic and clinical variables were collected, and statistical analyses were performed with the χ
2 test, Wilcoxon rank sum test, and Cox proportional hazards regression analysis. During 2019, 83 patients were diagnosed with PPC. During 2020, 113 patients were diagnosed with PPC. For both groups, the median time from symptom onset to diagnosis of PPC was 14 days (P = .13). No significant differences in time to diagnosis existed between the 2 years for location of diagnosis (outpatient clinic, emergency department, or in hospital), for computed tomographic imaging performed before diagnosis, or for number of COVID-19 tests received before PPC diagnosis. In addition, there were no differences in the 2 years between the total number of clinical visits before diagnosis. However, patients in the post-COVID-19 group who had fever were diagnosed with PPC earlier than those without fever (hazard ratio, 1.77; 95% confidence interval, 1.15–2.73; P = .01). Contrary to what we expected, no significant delay in diagnosis of PPC occurred during the COVID-19 pandemic.
A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom
Authors: Güven Aytaç Betül , Ünal Şeyma , Aytaç İsmail
Published: September 2022

Background:

The aim of this study was to compare anesthesiology residents’ acquisition of gripping and needling skills in either single-or double-operator ultrasound-guided nerve block using a hand-made phantom.

Design:

Prospective, randomized controlled study.

Methods:

After a tutorial session, 47 ultrasound-novice residents performed needling with double and single operator (Jedi, Bedforth, On-lock) grip techniques in each of the 3 interventional task sessions.

Results:

The time to perform the correct grip and needling decreased significantly between sessions for each technique (P < .001). While the double operator tasks required a shorter time than the single operator tasks in all 3 sessions (P < .001), there was no significant difference between the single-operator techniques. The number of needling attempts was similar between techniques and sessions. Participants rated the workload higher for the single-operator techniques on the National Aeronautics and Space Administration Task Load Index.

Conclusion:

Hands-on training of phantom models may be beneficial for the acquisition of single-operator grip skills.
Effects of bevel direction of endotracheal tube on the postoperative sore throat when performing fiberoptic‐guided tracheal intubation: A randomized controlled trial
Authors: Kim Hyunjee , Kim Jeong Eon , Yang Woo Seok , Hong Seong Wook , Jung Hoon
Published: September 2022

Background:

During fiberoptic-guided tracheal intubation, impingement between the distal tip of the endotracheal tube and the airway tissue can cause difficulties in tube insertion or tissue damage during the tube advancement over the bronchoscope. This randomized controlled study aimed to investigate the effects of the endotracheal tube’s bevel direction on the complications associated with airway injury when performing fiberoptic-guided tracheal intubation.

Methods:

The study subjects were divided into 2 groups: L (control) and D (study). When advancing the tube over the bronchoscope, the tube’s bevel was facing the patients’ left in Group L and the dorsal direction in Group D. According to the degree of resistance at the time of tube advancement, the insertion score was graded in 3 stages; the severity of the patients’ sore throat and hoarseness was evaluated and recorded postoperatively.

Results:

The severity of postoperative sore throat was higher in Group L than in Group D 3 hours and 24 hours after surgery. (P = .008, P = .023, respectively). The tube insertion score was comparable between the groups. The severity of postoperative hoarseness did not vary significantly between the groups.

Conclusion:

Endotracheal tube insertion with the bevel facing the dorsal direction of the patient during fiberoptic-guided tracheal intubation reduced the severity of postoperative sore throat in patients undergoing laparoscopic gynecologic surgery.
Prognostic value of preoperative P-CRP in patients with osteosarcoma: A retrospective study of 101 cases
Authors: Peng Hui , Fang Xu , Xu Yinglong , Wei Linhua , Qin Yiwu , Yang Fuchun , Lu Shenglin , Zhao Jinmin
Published: September 2022

This study aimed to investigate the value of the product of peripheral blood platelet and serum C-reactive protein (P-CRP), an inflammatory indicator, for the prognosis of patients with osteosarcoma. Patients with osteosarcoma who were diagnosed and treated at the First Affiliated Hospital of Guangxi Medical University, China, between January 2012 and December 2019 were included in this retrospective study. Receiver operating characteristic curves were used to calculate the optimal cut-off values for inflammatory indicators such as P-CRP, the C-reactive protein/albumin ratio (CRP/Alb), the neutrophil–lymphocyte ratio (NLR), and the platelet–lymphocyte ratio (PLR) in the peripheral blood of patients before treatment. Based on the cut-off values, the patients were divided into high P-CRP and low P-CRP groups, high CRP/Alb and low CRP/Alb groups, high NLR and low NLR groups, and high NLR and low NLR groups; the Kaplan–Meier method was used to compare the overall survival (OS) rates and OS times of the above groups. Univariate and multivariate Cox regression models were used to analyze the effects of various factors on the prognosis of osteosarcoma and to determine the independent influencing factors. The Kaplan–Meier survival analysis results suggested that the OS rate of the high P-CRP group was significantly lower than that of the low P-CRP group (14.0% vs 67.2%, P < .001). The univariate analysis results suggested that tumor volume, tumor stage, NLR, PLR, P-CRP and CRP/Alb were factors that affected the prognosis of patients with osteosarcoma, and the differences were statistically significant (P < .05). The multivariate analysis results showed that tumor volume (hazard ratio [HR] = 1.061; 95% CI, 1.001–1.125; P = .046) and preoperative P-CRP (HR, 1.037; 95% CI, 1.024–1.050; P < .01) were independent prognostic factors affecting the OS rate after osteosarcoma surgery. The results of our study showed that P-CRP is a novel and promising prognostic indicator for patients with osteosarcoma. The higher the P-CRP level in the peripheral blood of patients is before treatment, the worse the prognosis might be.
HLA-B27 negative reactive arthritis versus HLA-B27 positive reactive arthritis: A retrospective study
Authors: Ding Yimei , Xue Luan
Published: September 2022

Reactive arthritis (ReA) is defined as inflammatory arthritis secondary to an extra-articular infection with a key genetic background, HLA-B27. However, to date, the diagnosis and classification remain incomplete. The study focused on the similarities and differences in clinical manifestation, imaging features, and laboratory inspection between HLA-B27 negative patients and HLA-B27 positive patients in order to provide a reference for future development of diagnostic and classification criteria. Twenty-five ReA (19 HLA-B27 negative patients and 6 HLA-B27 positive patients) were included in this retrospective study. Clinical data, including demographics, clinical symptoms, imaging features, and laboratory inspection, were collected. The chi-square test and Mann–Whitney U test were used in the analysis. HLA-B27 negative group showed more involvement of upper extremities and small joints, while HLA-B27 positive group performed more axial symptoms. No significant difference was found in imaging features (ultrasound and magnetic resonance imaging) or laboratory inspection (microbes culture and infection-related indicators) between the 2 groups. ReA patients with different genetic backgrounds show various manifestations, although they encounter similar infections.
Yangxin decoction for the treatment of angina pectoris of coronary heart disease: A systematic review of randomized controlled trial
Authors: Yu Xiao-hong , Yu Xi-wen , Xu Zhe-ming , Li Hai-xiang
Published: September 2022

Background:

This study assessed the effectiveness of Yangxin Decoction (YXD) in the treatment of coronary heart disease (CHD) patients with angina pectoris (AP).

Methods:

In this study, we systematically and comprehensively searched the PUBMED, EMBASE, Cochrane Library, CNKI, WANGFANG, and VIP databases from their establishment to June 1, 2022. Clinical randomized controlled trials of YXD for the management of AP in patients with CHD were considered for inclusion. The outcomes included the response rate of AP, response rate based on electrocardiogram, and the rate of nitroglycerin use. Two authors independently performed literature selection, data extraction, and methodological quality assessment. Any differences were resolved by a third author through a discussion.

Results:

Nine trials involving 819 patients were included. The meta-analysis results showed that YXD significantly improved the response rate of AP (OR = 2.98, 95% CI: 1.96–4.55, I2 = 0%, P < .01) and the response rate based on the electrocardiogram (OR = 1.88, 95% CI: 1.28–2.78, I2 = 26%, P < .01), and significantly reduced the rate of nitroglycerin use (OR = 2.04, 95% CI: 1.19–3.52, I
2 = 0%, P = .01).

Conclusions:

The results of this study showed that YXD was effective in the treatment of patients with AP of CHD. Further studies are required to confirm these results.
Uterine tumor resembling ovarian sex cord tumor: A rare case report
Authors: Wang Xue-Ying , Zhang Mao-Chun , Chen Jiao , Huang Jiang-Hua
Published: September 2022

Rationale:

A uterine tumor resembling an ovarian sex cord tumor (UTROSCT) is a clinically rare disease with an unclear origin and biological behavior.

Patient concerns:

We present a case of UTROSCT in a 42-year-old woman who presented with abnormally increased menstrual volume for 2 years.

Diagnoses:

Initially, only ultrasound examination was performed to diagnose uterine fibroids, and then the tumor was surgically removed and sent for pathological examination. The patient was ultimately diagnosed with UTROSCT mainly based on pathological immunohistochemical examination and was further diagnosed with low malignant potential for recurrence based on genetic testing.

Interventions and Outcomes:

The patient underwent hysterectomy and bilateral adnexectomy, and no adjuvant radiotherapy or chemotherapy was performed after the surgery. Follow-up to date has indicated that she is in good condition.

Lessons:

UTROSCT is a rare disease that requires pathological immunohistochemical examination to confirm the diagnosis and genetic testing when necessary so that a clear diagnosis can inform better decision-making regarding treatment measures.
A rare case of alveolar hemorrhage with hypertensive emergency
Authors: Hamaguchi Sho , Suzuki Hitoshi , Hamaguchi Maki , Iwasaki Masako , Fukuda Hiromitsu , Takahara Hisatsugu , Tomita Shigeki , Suzuki Yusuke
Published: September 2022

Introduction:

Alveolar hemorrhage presents with severe respiratory failure, requiring prompt diagnosis and treatment. Alveolar hemorrhage is often caused by autoimmune diseases accompanied by progressive renal dysfunction. However, few cases without autoimmune diseases occur, making diagnosis difficult. Here, we report a case of alveolar hemorrhage with hypertensive emergency.

Patient concerns:

A 28-year-old man presented with dyspnea and bloody sputum. His blood pressure was 200/120 mm Hg.

Diagnosis:

The chest computed tomography showed suggestive of alveolar hemorrhage. Renal dysfunction and proteinuria were observed. However, autoantibodies were not detected. Echocardiogram revealed left ventricular function decrease. Ejection fraction was 20% to 30% with no ventricular asynergy or any valvular diseases. Brain magnetic resonance imaging showed hyperintense lesions on fluid-attenuated inversion recovery in the white matter of both cerebral and right cerebellar hemispheres, which were compatible with posterior reversible encephalopathy syndrome. Renal biopsy did not reveal any immune-mediated glomerulonephritis or vasculitis, but hypertensive nephropathy was diagnosed.

Interventions:

Blood pressure was controlled with combination therapy using calcium channel blocker, angiotensin II receptor blocker, α1 blocker, and β blocker.

Outcomes:

Alveolar hemorrhage and proteinuria improved with strict blood pressure control.

Conclusion:

This case indicates that severe hypertension can possibly cause alveolar hemorrhage. Accumulating these cases is important for general physicians to diagnose the alveolar hemorrhage with hypertensive emergency in its early stage and to avoid unnecessary treatment such as immunosuppressive therapy.
High dependency renal unit for the management of COVID-19 in patients with severe acute or chronic kidney disease
Authors: Thakare Sayali , Modi Tulsi , Gandhi Chintan , Bose Sreyashi , Deb Satarupa , Katyal Abhinav , Saxena Nikhil , Patil Ankita , Patil Sunil , Pajai Atim , Bajpai Divya , Jadhav Pratap , Jamale Tukaram
Published: September 2022

Coronavirus disease 2019 (COVID-19) in patients with severe impairment of kidney function is associated with high mortality. We evaluated the effect of high dependency renal unit (HDRU), with nephrologists as primary care physicians, as a quality improvement initiative for the management of these patients. This was a quasi-experimental observational study conducted at a tertiary care hospital in western India. Patients hospitalized for COVID-19 with pre-existing end-stage-renal-disease and those with severe AKI requiring dialysis (AKI-D) were included. For the first 2 months, these patients were cared for in medical wards designated for COVID-19, after which HDRU was set up for their management. With nephrologists as primary care providers, the 4 key components of care in HDRU included: care bundles focusing on key nephrology and COVID-19 related issues, checklist-based clinical monitoring, integration of multi-specialty care, and training of nurses and doctors. Primary outcome of the study was in-hospital mortality before and after institution of the HDRU care. Secondary outcomes were dialysis dependence in AKI-D and predictors of death. A total of 238 out of 4254 (5.59%) patients with COVID-19, admitted from 28th March to 30th September 2020, had severe renal impairment (116 AKI-D and 122 end-stage-renal-disease). 145 (62%) had severe COVID-19. From 28th May to 31st August 2020, these patients were managed in HDRU. Kaplan–Meier analysis showed significant improvement in survival during HDRU care [19 of 52 (36.5%) in pre-HDRU versus 35 of 160 (21.9%) in HDRU died, P ≤ .01]. 44 (67.7%) AKI-D survivors were dialysis dependent at discharge. Breathlessness and altered mental status at presentation, development of shock during hospital stay, and leukocytosis predicted mortality. HDRU managed by nephrologists is a feasible and potentially effective approach to improve the outcomes of patients with COVID-19 and severe renal impairment.
Surgical site infection in upper extremity fracture: Incidence and prognostic risk factors
Authors: Dong Xin
Published: September 2022

Upper extremity fractures (UEF) occurred in about 0.67% of males and females at some point in their lifetime. Surgical treatment has the advantage of good functional recovery, however, the occurrence of surgical site infection (SSI) affects the clinical outcome of operation. Currently, there are few studies focused on SSI of UEF. Consecutive patients with UEF and underwent surgeries from January 2010 to February 2021 were recruited. Demographic data, surgical related variables and laboratory test index of these patients were extracted and collected from the electronic medical records and picture archiving and communication system by well-trained investigators. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for continuous variables. Multivariate logistic regression analysis was performed to identify independent risk factors of SSI. In total, 286 patients with a mean age of 44.4 ± 16.6 years were identified for inclusion, 59.8% patients diagnosed with fracture of radius and ulna and 40.2% fractures located in the humerus, closed and open fractures were occurred in 252 and 34 adult patients respectively. 7.3% UEF patients were encountered with SSI, incidence of superficial and deep infection was 6.3% and 1.0%. Open fracture (OR, 8.33; P, .000), operation time longer than 122 minutes (OR, 3.12; P, .036), intraoperative blood loss more than 135 mL (OR, 3.98; P, .009) and albumin (ALB) lower than 40.8 g/L (OR, 3.60; P, .015) were demonstrated as independent risk factors of SSI. Adequate preoperative evaluation, careful intraoperative manipulation, and timely and appropriate postoperative interventions should be formulated to reduce the incidence of SSI in patients with the above perioperative high-risk factors.
Anti-N-methyl-D-aspartate receptor encephalitis after coronavirus disease 2019: A case report and literature review
Authors: Lee Hyesun , Jeon Jong Hyun , Choi Hojin , Koh Seong-Ho , Lee Kyu-Yong , Lee Young Joo , Kwon Hyuk Sung
Published: September 2022

Rationale:

Coronavirus disease 2019 (COVID-19) has become a global pandemic and COVID-19-associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis may occur through an immune-mediated pathomechanism.

Patient concerns:

A 21-year-old woman with a history of COVID-19 presented to our hospital with memory decline and psychiatric symptoms.

Diagnosis:

The patient was diagnosed with anti-NMDAR encephalitis.

Intervention:

Intravenous methylprednisolone (1 g/day over 5 days) followed by immunoglobulin (0.4 g/kg/day over 5 days) were administered. The patient underwent laparoscopic salpingo-oophorectomy to remove an ovarian teratoma.

Outcomes:

The patient was discharged with sequelae of short-term memory impairment, without other neuropsychiatric symptoms.

Lessons:

Cases of previously reported anti-NMDAR encephalitis with COVID-19 were reviewed and compared with the present case. Clinicians should be aware of the occurrence of anti-NMDAR encephalitis in patients who present with neuropsychiatric complaints during or after exposure to COVID-19. Further studies are required to determine the causal relationship between the 2 diseases and predict the prognosis of anti-NMDAR encephalitis after COVID-19 exposure.
Evaluation of the efficacy and safety of artemether emulsion on localized senile pruritus: A randomized pilot study
Authors: He Hui-Qiong , Shen Wen-Tong , Pei Qin , Fei Jian-Biao , Yu Yue , Qin Hai-Hong , Wang Guo-Jiang
Published: September 2022

Background:

Localized senile pruritus is a continued health problem for the elderly. This study aimed to evaluate the efficacy and safety of artemether emulsion on localized senile pruritus.

Methods:

Sixty patients diagnosed with senile pruritus were randomized into the artemether emulsion (1%) group or emulsion base group in a 1:1 ratio (the artemether group vs the control group). The patients used artemether emulsion or emulsion base for pruritus twice daily for 2 weeks. The pruritus visual analog scale (VAS) and the rate of adverse events were evaluated in week 0 and week 2.

Results:

The VAS scores in week 2 after treatment decreased significantly compared with those before treatment in both groups (P < .05). After treatment, patients receiving the artemether emulsion had significantly lower mean VAS scores compared to those who received the emulsion base (1.21 ± 1.64 vs 3.67 ± 2.97, P < .05). When the VAS scores were compared between the 2 groups before treatment, the effective rate of the artemether group was significantly higher than that of the control group (χ
2 = 55, P < .05) in week 2 after treatment. Besides, no adverse events occurred in both groups.

Conclusions:

Both artemether emulsion and emulsion base were effective in treating localized senile pruritus, and artemether emulsion was superior to emulsion base.
Prophylactic effect of intravenous lidocaine against cognitive deficit after cardiac surgery: A PRISMA-compliant meta-analysis and trial sequential analysis
Authors: Hung Kuo-Chuan , Ho Chun-Ning , Liu Wei-Cheng , Yew Ming , Chang Ying-Jen , Lin Yao-Tsung , Hung I-Yin , Chen Jen-Yin , Huang Ping-Wen , Sun Cheuk-Kwan
Published: September 2022

Background:

This study aimed at providing an updated evidence of the association between intraoperative lidocaine and risk of postcardiac surgery cognitive deficit.

Methods:

Randomized clinical trials (RCTs) investigating effects of intravenous lidocaine against cognitive deficit in adults undergoing cardiac surgeries were retrieved from the EMBASE, MEDLINE, Google scholar, and Cochrane controlled trials register databases from inception till May 2021. Risk of cognitive deficit was the primary endpoint, while secondary endpoints were length of stay (LOS) in intensive care unit/hospital. Impact of individual studies and cumulative evidence reliability were evaluated with sensitivity analyses and trial sequential analysis, respectively.

Results:

Six RCTs involving 963 patients published from 1999 to 2019 were included. In early postoperative period (i.e., 2 weeks), the use of intravenous lidocaine (overall incidence = 14.8%) was associated with a lower risk of cognitive deficit compared to that with placebo (overall incidence = 33.1%) (relative risk = 0.49, 95% confidence interval: 0.32–0.75). However, sensitivity analysis and trial sequential analysis signified insufficient evidence to arrive at a firm conclusion. In the late postoperative period (i.e., 6–10 weeks), perioperative intravenous lidocaine (overall incidence = 37.9%) did not reduce the risk of cognitive deficit (relative risk = 0.99, 95% confidence interval: 0.84) compared to the placebo (overall incidence = 38.6%). Intravenous lidocaine was associated with a shortened LOS in intensive care unit/hospital with weak evidence.

Conclusion:

Our results indicated a prophylactic effect of intravenous lidocaine against cognitive deficit only at the early postoperative period despite insufficient evidence. Further large-scale studies are warranted to assess its use for the prevention of cognitive deficit and enhancement of recovery (e.g., LOS).
Liver abscess in advanced hepatocellular carcinoma after atezolizumab plus bevacizumab treatment: A case report
Authors: Uchida Keisuke , Ozono Yoshinori , Uchiyama Naomi , Hatada Hiroshi , Nakamura Kenichi , Komaki Yuri , Iwakiri Hisayoshi , Hasuike Satoru , Nagata Kenji , Sato Yuichiro , Kawakami Hiroshi
Published: September 2022

Rationale:

Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC.

Patient concerns:

A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital.

Diagnosis:

Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess.

Interventions:

Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed.

Outcomes:

Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient’s respiratory condition and renal function gradually worsened; The patient’s general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37.

Lessons:

We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.
Security research of blockchain technology in electronic medical records
Authors: Qu Jia
Published: September 2022

Background:

A blockchain-based Electronic Health Record(EHR) data-sharing scheme was proposed to solve the problems of data sharing difficulties and privacy disclosure.

Methods:

This paper designs a blockchain-based electronic health record model based on the characteristics of blockchain antitampering, decentralization, and distributed storage. Utilize blockchain network and distributed database to store encryption-related access control policies to prevent EHR data from being tampered with and leaked. Data security sharing protocol combines Distributed Key Generation (DKG) and reencryption.

Results:

The protocol used the Delegated Proof of Stake(DPOS) algorithm to select the proxy node, which reencrypted the EHR to share data between a pair of users. Simulation experiments and comparative analysis showed that DPOS efficiency was higher than Proof of Work (POW) and slightly lower than the Practical Byzantine Fault Tolerance(PBFT).

Conclusions:

The scheme proposed in this paper is more decentralized and less computationally intensive.
Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial
Authors: Tan Kok Wang , Sayed Masri Syarifah Noor Nazihah , Musthafa Qurratu Aini , Mohd Azidin Azrin , Nik Mohamed Kamil Amiruddin , Izaham Azarinah , Md Nor Nadia
Published: September 2022

Background:

The serratus plane block is an effective technique for providing analgesia to patients undergoing breast surgery.

Methods:

This prospective, double-blind, randomized study enrolled 60 female patients scheduled for unilateral mastectomy and axillary clearance. The patients received either a superficial serratus plane block or deep serratus plane block. Dermatomal spread was recorded 30 minutes after block administration. Postoperatively, pain visual analog scale (VAS) scores were documented at recovery (time 0), at 30 minutes; and in the ward hourly for 4 hours, and 4-hourly until 24 hours postoperatively. The time to first analgesic rescue and cumulative morphine consumption using patient-controlled analgesia morphine (PCAM) were recorded.

Results:

The results showed lower VAS scores at rest (at 1, 2, 3, and 4 hours postoperatively), and during movement (at 1, 2, 3, 4, 8, and 24 hours postoperatively) in the superficial serratus plane block group, P < .005. Similarly, cumulative morphine usage was lower in the superficial serratus plane group, P < .005. The time to the first rescue analgesic was also significantly longer in the superficial group, P < .001. More patients in the superficial serratus plane group achieved greater dermatomal spread at T2 and T7 than those in the deep group.

Conclusions:

Superficial serratus plane block provides better analgesic efficacy than deep serratus plane block in mastectomy and axillary clearance.
Transferrin saturation as a surrogate marker for assessment of labile nontransferrin bound iron in chronic liver disease
Authors: Oliveira Patricia Marinho Costa de , Espósito Breno Pannia , Carvente Claudia , Silva Genimari Arruda , Dellavance Alessandra , Baldo Danielle Cristiane , Ferraz Maria Lucia Gomes
Published: September 2022

Background

Increased transferrin saturation (TS) and ferritin are common in hereditary hemochromatosis (HH) but also in chronic liver diseases (CLD). Nontransferrin bound iron (NTBI) is believed to be associated with iron-induced cell damage. We aimed to evaluate NTBI in CLD and their relationship with liver damage.

Methods

Two groups of patients were studied. Group 1 (G1): 94 CLD patients from an Outpatient Hepatology Unit. Group 2 (G2): 36 healthy individuals form a Medical Checkup Clinic. Transferrin iron-binding capacity, TS, ferritin, AST, ALT, and red cell count were performed using standard tests. NTBI was assessed as enhanced labile plasma iron (eLPi). Levels of eLPi less than 0.4 µmol/l were considered within the normal range.

Results

Prevalence of increased iron tests (elevated TS and ferritin) was 14% in G1 and 5.5% in G2 (P = 0.19). Positive NTBI was found in 12 patients (11 in G1 and 1 in G2). Positivity to NTBI was associated with increased iron tests (P = 0.03), cirrhosis (P = 0.03) and AST index (ASTI) (P = 0.03). NTBI was associated with TS of more than 70% (P = 0.002) but not to elevated ferritin (P = 0.74). Variables strongly associated with a positive NTBI in univariate analysis (TS > 70%, cirrhosis and ASTI) were submitted to binary regression analysis. TS of more than 70% was the only independent predictive factor (P = 0.049; odds ratio, 6.8).

Conclusion

NTBI was associated with TS in CLD, but not with ferritin. NTBI testing could be useful for CLD patients with increased iron tests. Alternatively, a TS of more than 70% can be used as a surrogate marker.
Identification of ceRNA regulatory network in acute pancreatitis and acute recurrent pancreatitis
Authors: Liu Hang , Huang Wei , Feng Yuxi , Li Yu , Li Jinzhi , Mai Gang
Published: September 2022

Objective

The aim of this study was to find differentially expressed long noncoding RNAs (lncRNAs), microRNAs (miRNAs) and mRNAs and related signaling pathways, contributing to understanding the molecular mechanism of acute recurrent pancreatitis (ARP).

Methods

First, peripheral whole blood samples from five acute pancreatitis (AP) patients, five ARP patients and five healthy individuals (N) were collected for RNA sequencing. Second, differentially/specifically expressed lncRNAs, miRNAs and mRNAs were identified in AP vs. N, ARP vs. N and ARP. Third, the ceRNA (lncRNA-miRNA-mRNA) networks of common/specifical lncRNAs, miRNAs and mRNAs were constructed in AP vs. N, ARP vs. N and ARP. Finally, functional analysis of common mRNAs in AP vs. N and ARP vs. N was performed.

Results

A total of 315 common lncRNAs, 12 common miRNAs and 909 common mRNAs were identified between AP and ARP. Ninety-four specifically expressed lncRNAs, one specifically expressed miRNAs and 286 specifically expressed mRNAs were found in ARP. Some interaction pairs were identified in AP and ARP, such as LUCAT1/NEAT1-hsa-miR-16-2-3p-HK2, CHRM3-AS2-hsa-miR-122-5p/hsa-miR-145-3p-DBH/CACNA1C, CHRM3-AS2-hsa-miR-200a-3p-PDGFD, RBM26-AS1-hsa-miR-200b-3p-FHIT and LINC00891/KTN1-AS1-hsa-miR-143-3p-tyrosine kinase (TXK). ASAP1-IT2/DGCR9-hsa-miR-342-5p-ABCC5/MAP2K6 was the only one specific interaction pair identified in ARP. Four significantly enriched signaling pathways were identified in AP vs. N and ARP vs. N, including amino sugar and nucleotide sugar metabolism (involved NPL and HK2), MAPK signaling pathway (involved CACNA1C and PDGFD), metabolic pathways (involved DBH and FHIT) and leukocyte transendothelial migration (involved TXK).

Conclusion

The identified altered lncRNAs, miRNAs, mRNAs and related signaling pathways may be involved in the AP development and recurrence.
Relationship of Functional Constipation and Growth Status: A Systematic Review and Meta-Analysis
Authors: Lazarus Glen , Junaidi Michelle Clarissa , Oswari Hanifah
Published: September 2022

Objectives:

Functional constipation (FC) and malnutrition are 2 of the most common diseases affecting children worldwide with long-term consequences. We hereby performed a systematic review and meta-analysis to analyze the relationship between these 2 entities.

Methods:

We searched PubMed, American Academics of Pediatrics (AAP), Cochrane, ClinicalTrials.gov (from inception to December 11, 2021) using “constipation,” “growth,” and “children” as the keywords. Newcastle-Ottawa Scale was used as the risk of bias assessment tool. Meta-analysis using the random-effects model was done.

Results:

Eighteen studies involving 33,410 children were chosen in this study. Meta-analysis of all the studies showed statistically significant relationship between FC with both overweight/obesity [odds ratio (OR) = 1.75; 95% confidence interval (CI) = 1.11-2.76; P = 0.02], in Asian countries subgroup, and undernutrition (OR = 2.38; 95% CI = 1.43-3.97; P < 0.001) in Asian countries using ROME criteria’s subgroup. Normal weight patients were also more prevalent in non-FC patients in Asia (OR = 0.54; 95% CI = 0.38-0.76; P < 0.001). The relationship between FC and short stature is still inconclusive.

Conclusions:

FC is correlated with the prevalence of both overweight/obesity and undernutrition. Future studies should evaluate the causal relationship and whether FC treatment could help.
Derivation and Validation of Vasoactive Inotrope Score Trajectory Groups in Critically Ill Children With Shock
Authors: Perizes Elitsa N. , Chong Grace , Sanchez-Pinto L. Nelson
Published: September 2022

OBJECTIVES:

To determine whether there are clinically relevant and reproducible Vasoactive Inotrope Score (VIS) trajectories in children with shock during the acute phase of critical illness.

DESIGN:

Retrospective, observational cohort study.

SETTING:

Two tertiary, academic PICUs.

PATIENTS:

Children (< 18 yr old) who required vasoactive infusions within 24 hours of admission to the PICU. Those admitted post cardiac surgery were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

An hourly VIS was calculated for the first 72 hours after initiation of vasoactives. Group-based trajectory modeling (GBTM) was applied to a derivation set (75% of encounters) and compared with the trajectories in a validation set (25% of encounters) using the same variables. The primary outcome was in-hospital mortality, and the secondary outcome was multiple organ dysfunction syndrome (MODS) on day 7. A total of 1,828 patients met inclusion criteria, and 309 (16.9%) died. GBTM identified four subgroups that were reproducible in the validation set: “Mild, fast resolving shock” (n = 853 [47%]; mortality 9%), “Moderate, slow resolving shock” (n = 422 [23%]; mortality 15%), “Moderate, prolonged shock” (n = 312 [17%]; mortality 21%), and “Severe, prolonged shock” (n = 241 [13%]; mortality 40%). There was a significant difference in mortality, MODS on day 7, and suspected infection (p < 0.001) across groups. The “Mild, fast resolving shock” and “Severe, prolonged shock” groups were identifiable within the first 24 hours. The “Moderate, slow resolving” and “Moderate, prolonged shock” groups were indistinguishable in the first 24 hours after initiation of vasoactives but differed in in-hospital mortality and MODS on day 7. Hydrocortisone administration was independently associated with poor outcomes in the “Mild, fast resolving shock” group.

CONCLUSIONS:

We uncovered four distinct and reproducible VIS trajectory groups that were associated with different risk factors, response to therapy, and outcomes in children with shock. Characterizing VIS trajectory groups in the acute phase of critical illness may enable better prognostication and more targeted management.
Trends in Rates of Surgery and Postoperative Mortality Among Patients Receiving Chronic Kidney Replacement Therapy
Authors: Palamuthusingam Dharmenaan , Hawley Carmel M. , Pascoe Elaine M. , Johnson David W. , Sivalingam Palvannan , McDonald Stephen , Boudville Neil , Jose Matthew D. , Talaulikar Girish , Fahim Magid
Published: September 2022

Objective:

To estimate the incidence and postoperative mortality rates of surgery, and variations by age, diabetes, kidney replacement therapy (KRT) modality, and time over a 15-year period.

Background:

Patients with kidney failure receiving chronic KRT (dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. Contemporary data on the incidence and types of surgery these patients undergo are lacking.

Methods:

This binational population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients were categorized by their KRT modality (hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplant) for each calendar year. Incidence rates for overall surgery and subtypes were estimated using Poisson models. Logistic regression was used to estimate 30-day/in-hospital mortality risk.

Results:

Overall, 46,497 patients over a median (interquartile range) follow-up of 6.3 years (3.5–10.2 years) underwent 81,332 surgeries. The median incidence rate of surgery remained stable over this period with a median of 14.9 surgeries per 100 patient-years. Annual incidence rate was higher in older people and those with diabetes mellitus. Patients receiving hemodialysis had a higher incidence rate of surgery compared with kidney transplant recipients (15.8 vs 10.0 surgeries per 100 patient-years, respectively). Overall adjusted postoperative mortality rates decreased by >70% over the study period, and were lowest in kidney transplant recipients (1.7%, 95% confidence interval, 1.4–2.0). Postoperative mortality following emergency surgery was >3-fold higher than elective surgery (8.4% vs 2.3%, respectively).

Conclusions:

Patients receiving chronic KRT have high rates of surgery and morbidity. Further research into strategies to mitigate perioperative risk remain a priority.
Juvenile Mucopolysaccharidosis plus disease caused by a missense mutation inVPS33A
Authors: Pavlova Elena V. , Lev Dorit , Michelson Marina , Yosovich Keren , Michaeli Hila Gur , Bright Nicholas A. , Manna Paul T. , Dickson Veronica Kane , Tylee Karen L. , Church Heather J. , Luzio J. Paul , Cox Timothy M.
Published: September 2022

Background

A rare and fatal disease resembling mucopolysaccharidosis in infants, is caused by impaired intracellular endocytic trafficking due to deficiency of core components of the intracellular membrane-tethering protein complexes, HOPS and CORVET.

Methods

Whole Exome Sequencing identified a novel VPS33A mutation in a patient suffering from a variant form of mucopolysaccharidosis. Electron and confocal microscopy, immunoblotting, and glycosphingolipid trafficking experiments were undertaken to investigate the effects of the mutant VPS33A in patient-derived skin fibroblasts.

Results

We describe an attenuated juvenile form of VPS33A-related syndrome - mucopolysaccharidosis plus in a man who is homozygous for a hitherto unknown missense mutation (NM_022916.4: c.599 G>C; R200P) in a conserved region of the VPS33A gene. Urinary glycosaminoglycan analysis revealed increased heparan, dermatan sulphates and hyaluronic acid. We showed decreased abundance of VPS33A in patient derived fibroblasts and provided evidence that the R200P mutation leads to destabilisation of the protein and proteasomal degradation. As in the infantile form of mucopolysaccharidosis plus, the endocytic compartment in the fibroblasts also expanded – a phenomenon accompanied by increased endolysosomal acidification and impaired intracellular glycosphingolipid trafficking. Experimental treatment of the patient’s cultured fibroblasts with the proteasome inhibitor, bortezomib, or exposure to an inhibitor of glucosylceramide synthesis, eliglustat, improved glycosphingolipid trafficking.

Conclusion

To our knowledge this is the first report of an attenuated juvenile form of VPS33A insufficiency characterised by appreciable residual endosomal-lysosomal trafficking and a milder mucopolysaccharidosis plus than the disease in infants. Our findings expand the proof of concept of redeploying clinically approved drugs for therapeutic exploitation in patients with juvenile as well as infantile forms of mucopolysaccharidosis plus disease.
GHSI COVID-19 puzzle: did highly developed countries indeed fare worse?
Authors: Markovic Sofija , Salom Igor , Rodic Andjela , Djordjevic Marko
Published: September 2022

Global Health Security Index (GHSI) categories are formulated to assess the capacity of world countries to deal with infectious disease risks. Thus, higher values of these indices were expected to translate to lower COVID-19 severity. However, it turned out to be the opposite, surprisingly suggesting that higher estimated country preparedness to epidemics may lead to higher disease mortality. To address this puzzle, we:i) use a model-derived measure of COVID-19 severity;ii) employ a range of statistical learning approaches, including non-parametric machine learning methods;iii) consider the overall excess mortality, in addition to official COVID-19 fatality counts. Our results suggest that the puzzle is, to a large extent, an artifact of oversimplified data analysis and a consequence of misclassified COVID-19 deaths, combined with the higher median age of the population and earlier epidemics onset in countries with high GHSI scores.
The Proteome Landscape of Human Placentas for Monochorionic Twins with Selective Intrauterine Growth Restriction
Authors: Meng Xin-Lu , Yuan Peng-Bo , Wang Xue-Ju , Hang Jing , Shi Xiao-Ming , Zhao Yang-Yu , Wei Yuan
Published: September 2022

In perinatal medicine, intrauterine growth restriction (IUGR) is one of the greatest challenges. The etiology of IUGR is multifactorial, but most cases are thought to arise from placental insufficiency. However, identifying the placental cause of IUGR can be difficult due to numerous confounding factors. Selective IUGR (sIUGR) would be a good model to investigate how impaired placentation affects fetal development, as the growth discordance between monochorionic twins cannot be explained by confounding genetic or maternal factors. Herein we constructed and analyzed the placental proteomic profiles of IUGR twins and the normal cotwins. Specifically, we identified a total of 5481 proteins and 233 differentially expressed proteins (DEPs), including 57 upregulated and 176 downregulated DEPs in IUGR twins. Bioinformatic analysis indicates that these DEPs are mainly associated with cardiovascular system development and function, organismal survival, and organismal development. Notably, 34 DEPs are significantly enriched in angiogenesis, and diminished placental angiogenesis in IUGR twins has been further elaborately confirmed. Moreover, we found decreased expression of metadherin (MTDH) in placentas for IUGR twins and demonstrated that MTDH contributes to placental angiogenesis and fetal growth in vitro. Collectively, our findings reveal the comprehensive proteomic signature of placentas for sIUGR twins, and the DEPs identified may provide in-depth insights into pathogenesis of placental dysfunction and subsequent impaired fetal growth.
The time-varying association between previous antibiotic use and antibiotic resistance
Authors: Baraz Avi , Chowers Michal , Nevo Daniel , Obolski Uri
Published: September 2022

Objectives

The objective of the study was to estimate how the time elapsed from previous antibiotic use is associated with antibiotic resistance.

Methods

Data comprised electronic medical records of all patients in an Israeli hospital who had a positive bacterial culture between 2016-19. These included susceptibility testing results, and clinical and demographic data. Mixed-effects time-varying logistic models were fitted to estimate the association between time elapsed since last use of aminoglycosides and gentamicin resistance (n= 13,095), cephalosporins and ceftazidime resistance (n= 13,051), and fluoroquinolones and ciprofloxacin resistance (n= 15,364), while adjusting for multiple covariates.

Results

For all examined antibiotics, previous antibiotic use had a statistically significant association with resistance (p< 0.001). These associations exhibited a clear decreasing pattern over time, which we present as a flexible function of time. Nonetheless, previous antibiotic use remained a significant risk factor for resistance for at least 180 days, with adjusted odds ratios of 1.94 (95% CI 1.40-2.69), 1.33 (95% CI 1.10-1.61), and 2.25 (95% CI 1.49-3.41), for gentamicin, ceftazidime and ciprofloxacin, respectively.

Conclusions

The association between prior antibiotic use and resistance decreases over time. Commonly used cut-offs for prior antibiotic use can either misclassify patients still at higher risk, when too recent; or provide a diluted estimate of the effects of antibiotic use on future resistance, when too distant. Hence, prior antibiotic use should be considered as a time-dependent risk factor for resistance, both in epidemiological research and clinical practice.