bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative development of pulmonary thromboembolism in a bedridden patient owing to a pelvic bone fracture with negative preoperative computed tomography pulmonary angiographic findings
Authors: Kim Jong Hae , Lim Hyungseop , Kim Hyun Mi , Lim Jung A.
Published: August 2021

Rationale:

Pulmonary thromboembolism (PTE) is a potentially life-threatening condition with high morbidity and mortality, and computed tomographic pulmonary angiography (CTPA) is an important diagnostic tool for patients in whom PTE is suspected; however, intraoperative PTE is very difficult to diagnose and often has a rapid clinical course. We experienced a case of intraoperative PTE with persistent tachycardia refractory to conventional treatments despite negative preoperative CTPA findings.

Patient concerns:

A 53-year-old man with a pelvic bone fracture who had been on bed rest for 10 days underwent open reduction and internal fixation under general anesthesia. He remained tachycardic (heart rate of 120 beats/min) despite treatments with fluid resuscitation, analgesics, and beta-blockers.

Diagnoses:

Preoperative CTPA, computed tomography (CT) venography, and transthoracic echocardiography showed no signs of deep vein thrombosis and PTE. However, the levels of D-dimer were elevated. After the start of the surgery, tachycardia (heart rate between 100 and 110 beats/min) could not be treated with fluid resuscitation. Systolic blood pressure was maintained between 90 and 100 mm Hg using continuous infusion of phenylephrine. Ninety minutes after the surgery, systolic and diastolic blood pressures suddenly dropped from 100/60 to 30/15 mm Hg with a decrease in end-tidal carbon dioxide concentration from 29 to 13 mm Hg and development of atrial fibrillation. Arterial blood gas analysis revealed hypercapnia. Under the suspicion of PTE, cardiopulmonary resuscitation (CPR) was immediately initiated. Three CPR cycles raised the blood pressure back to 90/50 mm Hg with sinus tachycardia (115 beats/min). Transesophageal echocardiography showed right ventricular dysfunction and paradoxical septal motion. However, emboli were not found. Postoperative chest CT revealed massive PTE in both pulmonary arteries.

Interventions:

Immediately, surgical embolectomy was performed uneventfully.

Outcomes:

The patient was discharged from the hospital 1 month later without any complications.

Lessons:

The patient with moderate risk for PTE (heart rate > 95 beats/min and immobilization, surgery under general anesthesia, and lower limb fracture within 1 month) should be closely monitored and managed intraoperatively even if preoperative CTPA findings are negative. The development of PTE needs to be expected if tachycardia is refractory to conventional treatments.
Vitamin D status and healthy Egyptian adolescents
Authors: Sherief Laila M. , Ali Adel , Gaballa Ahmed , Abdellatif Ghada Mohammed , Kamal Naglaa M. , Afify Mona R. , Abdelmalek Diana H. , El-Emari Sameh A. , Soliman Ahmed S.A. , Mokhtar Wesam A.
Published: August 2021

Vitamin D deficiency is a worldwide public health problem. Low vitamin D and its consequences among children and adolescents could be considered as one of the most important health-related problems. This study aimed to estimate the prevalence of vitamin D deficiency in healthy Egyptian adolescents and investigate factors associated with vitamin D status.

A cross-sectional study was conducted on 572 school children (270 males and 302 females) aged 14 to 18 years, who were randomly selected from high schools in one governorate in Egypt. Data were collected through a self-administered questionnaire. Vitamin D level, serum calcium, phosphorus, alkaline phosphates were measured.

Vitamin D deficiency was almost present in all the studied Egyptian healthy adolescents (99%), 94.8% had vitamin D deficiency and 4.2% had vitamin D insufficiency. Girls had a higher prevalence of vitamin D deficiency than boys. There was a significant association between lack of physical activity, sun exposure, and vitamin D deficiency.

Vitamin D deficiency and insufficiency are highly prevalent. In sunny countries, the special pattern of conservative clothing and the lack of outdoor physical activity might be the underlying factors for the high prevalence in females. Vitamin D supplementation seems to be mandatory to halt the problem.
Effects of perioperative interventions for preventing postoperative delirium
Authors: Li Xia , Wang Yanting , Liu Jie , Xiong Yue , Chen Shiqiang , Han Jingjing , Xie Wanli , Wu Qingping
Published: August 2021

Background:

Postoperative delirium (POD) not only increases the medical burden but also adversely affects patient prognosis. Although some cases of delirium can be avoided by early intervention, there is no clear evidence indicating whether any of these measures can effectively prevent POD in specific patient groups.

Objective:

The aim of this meta-analysis was to compare the efficacy and safety of the existing preventive measures for managing POD.

Methods:

The PubMed, OVID (Embase and MEDLINE), Web of Science, and the Cochrane Library databases were searched for articles published before January 2020. The relevant randomized controlled trials (RCTs) were selected based on the inclusion and exclusion criteria. Data extraction and methodological quality assessment were performed according to a predesigned data extraction form and scoring system, respectively. The interventions were compared on the basis of the primary outcome like incidence of POD, and secondary outcomes like duration of delirium and the length of intensive care unit and hospital stay.

Results:

Sixty-three RCTs were included in the study, covering interventions like surgery, anesthesia, analgesics, intraoperative blood glucose control, cholinesterase inhibitors, anticonvulsant drugs, antipsychotic drugs, sleep rhythmic regulation, and multi-modal nursing. The occurrence of POD was low in 4 trials that monitored the depth of anesthesia with bispectral index during the operation (P < .0001). Two studies showed that supplementary analgesia was useful for delirium prevention (P = .002). Seventeen studies showed that perioperative sedation with α2-adrenergic receptor agonists prevented POD (P = .0006). Six studies showed that both typical and atypical antipsychotic drugs can reduce the incidence of POD (P = .002). Multimodal nursing during the perioperative period effectively reduced POD in 6 studies (P < .00001). Furthermore, these preventive measures can reduce the duration of delirium, as well as the total and postoperative length of hospitalized stay for non-cardiac surgery patients. For patients undergoing cardiac surgery, effective prevention can only reduce the length of intensive care unit stay.

Conclusion:

Measures including intraoperative monitoring of bispectral index, supplemental analgesia, α2-adrenergic receptor agonists, antipsychotic drugs, and multimodal care are helpful to prevent POD effectively. However, larger, high-quality RCTs are needed to verify these findings and develop more interventions and drugs for preventing postoperative delirium.
Expression and clinical significance of inhibitory receptor Leukocyte-associated immunoglobulin-like receptor-1 on peripheral blood T cells of chronic hepatitis B patients
Authors: Gu Yurong , Bi Yanhua , Wei Huan , Li Jing , Huang Zexuan , Liao Chunhong , Liao Weixin , Huang Yuehua
Published: August 2021

Leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1) is an inhibitory receptor that is expressed on the surface of multiple immune cells and plays key roles in immune modulation. In patients with chronic hepatitis B (CHB), T cell number and functions are abnormal and the expression of inhibitory receptors is elevated. However, the expression of LAIR-1 on T cells in patients with CHB is still undetermined.

We recruited 320 patients with CHB in different disease phases and 17 healthy donors. Serum biochemical and virological examinations were performed for each participant, and their demographic and clinical data were collected. According to the latest American Association for the Study of Liver Disease guidelines, we categorized the patients into 4 groups: immune active, immune tolerant, inactive CHB, and gray zone. Additionally, we tested the expression of LAIR-1 on T cells and T cell subsets using flow cytometry.

We observed a significant decrease in LAIR-1 expression on CD3+ T cells and its two subsets (CD4+ and CD8+ T cells) in patients with CHB. LAIR-1 expression on T cells was the lowest in the immune active group. LAIR-1 expression levels on CD4+ and CD8+ T cells showed a significant negative association with hepatitis B virus (HBV) DNA load and were lower in hepatitis B e antigen (HBeAg)-positive patients than in HBeAg-negative patients (P < .05). In addition, LAIR-1 expression levels on CD3+, CD4+, and CD8+ T cells were all negatively associated with liver inflammation and fibrosis parameters, such as alanine aminotransferase and aspartate aminotransferase levels, FibroScan value, and aspartate aminotransferase-to-platelet ratio index score.

LAIR-1 expression levels on T cells were associated with HBV DNA load and liver inflammation and fibrosis parameters, indicating that LAIR-1 may play an important regulatory role in HBV-induced T cell immune pathogenesis and may be a therapeutic target for CHB.
Comparative efficacy and safety of Chinese herbal medicine for knee osteoarthritis
Authors: Yang Lei , Wu Bo-yu , Ma Lu , Li Zheng-dong , Xiong Hui
Published: August 2021

Background:

Knee osteoarthritis (OA) is a major public health concern causing chronic disability as well as a substantial burden on health care and the economy. However, effective treatments for knee OA were still not available. Numerous clinical studies have suggested that Chinese herbal medicine (CHM) seems to be clinically effective in treating knee OA. Thus, this study aims to evaluate the efficacy and safety of CHM in the treatment of knee OA through a systematic review and network meta-analysis.

Methods:

A comprehensive search will be performed in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database, Chinese Biomedical Database, and 3 clinical trials registration websites, from the database inception to May 2021. Randomized controlled trials meeting the eligible criteria based on the PICOS framework will be included. All studies fulfilling the eligible criteria will be assessed for risk of bias using the Cochrane Collaboration's tool. The primary outcome will be the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index, and total effective rate. The secondary outcome is the incidence of adverse events. Data analysis will be performed using Stata, Addis, and WinBUGS.

Discussion:

This study will provide a reliable evidence to assess effectiveness and safety of CHM for knee OA, which may provide guidance for clinical practice.

Systematic review registration:

This study protocol has been registered on INPLASY202160060.
Efficacy and safety of pembrolizumab/carrelizumab, alone or in combination with chemotherapy in treatment of patients with non-small cell lung cancer
Authors: Zhang Xiaofei , Qian Hui , Qu Xiangkun , Jiang Yalin
Published: August 2021

Background:

To date, there have been no reported trials that directly compare pembrolizumab/carrelizumab monotherapy versus pembrolizumab/carrelizumab and chemotherapy in the first-line treatment setting of advanced/metastatic non-small cell lung cancer (NSCLC). We performed a Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of pembrolizumab/carrelizumab versus pembrolizumab/carrelizumab and chemotherapy in previously treated patients with NSCLC.

Methods:

The following search terms would be used in PUBMED, Scopus, EMBASE, and Cochrane Library databases on July 20, 2021, as the search algorithm: (pembrolizumab) OR (carrelizumab) OR (programmed death-1) AND (non-small cell lung cancer) OR (NSCLC). All RCTs that reported the outcomes of pembrolizumab/carrelizumab with or without chemotherapy compared with those of pembrolizumab/carrelizumab alone for patients with NSCLC were considered eligible for inclusion in this meta-analysis. The primary outcomes of interest were overall survival, progression-free survival, objective response rate based on the Response Evaluation Criteria in Solid Tumors for complete and partial responses, and treatment-related adverse events including immune-related adverse events. Secondary outcomes included overall survival, progression-free survival, objective response rate, and treatment-related adverse events for the FDA-approved doses.

Conclusions:

The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Ethical approval:

As this study is on the basis of published or registered previous studies, ethical approval and informed consent of patients are not required.
The safety and efficacy of chemotherapy combined with immunotherapy for pancreatic cancer
Authors: Huang Yang , Yan Xu , Ren Tian , Yi Fan , Li Qi , Zhang Chunyang
Published: August 2021

Background:

Since the combination of chemotherapy and immunotherapy, such as new molecular targeted drugs or vaccines, is controversial in terms of survival advantages compared with chemotherapy therapy alone, we conducted a meta-analysis to compare the efficacy and safety of immunotherapy combined with chemotherapy and chemotherapy alone for advanced pancreatic cancer.

Methods:

We searched PubMed, Embase, and Cochrane Library from the establishment of the database to November 2020. We included some studies that reported pancreatic cancer patients receiving immunotherapy, and we excluded duplicate publications, research without full text, incomplete information or inability to conduct data extraction, animal experiments, reviews, and systematic reviews.

Results:

The risk ratio of the objective response rate and disease control rate was 1.10 (95% confidence interval [CI]: 0.88–1.38) and 1.17 (95% CI: 1.06–1.31), respectively, indicating that there was no significant difference between the objective response rate of combination therapy and chemotherapy alone, while the disease control rate of the combined treatment was higher than that of chemotherapy alone. The hazard ratio of overall survival and progression-free survival was 0.91 (95% CI: 0.82–1.01) and 0.87 (95% CI: 0.77–0.98), respectively, indicating that there was no significant difference between the overall survival of combination therapy and chemotherapy alone, while progression-free survival of the combined treatment was longer than that of chemotherapy alone. We also found that in addition to the combination treatment, the incidence of vomiting in pancreatic cancer was higher than that of chemotherapy alone, and the incidence of other complications was not significantly different from that of treatment alone.

Conclusion:

Chemotherapy combined with immunotherapy for pancreatic cancer not only improves treatment efficiency but also does not cause serious adverse reactions. This treatment strategy should be widely used clinically.
Circulating tumor cells counts are associated with CD8+ T cell levels in programmed death-ligand 1-negative non-small cell lung cancer patients after radiotherapy
Authors: Liu Qingyun , Zhao Chaoren , Jiang Penghui , Liu Dawei
Published: August 2021

This study aimed to explore the dynamics of circulating tumor cells (CTCs) and CD8+ T cells in stage II–III non-small cell lung cancer patients with CTCs in different programmed death-ligand 1 (PD-L1) status treated with radiotherapy and evaluate the correlation between CTCs and CD8+ T cells.

This study was a retrospective study which reviewed 69 stage II–III non-small cell lung cancer patients underwent postoperative radiotherapy and peripheral blood tests of CTCs and T lymphocyte were available before radiation, 1 week after radiation and 1 month after radiation.

In this study, 25 patients had PD-L1 positive CTCs and 44 patients had PD-L1 negative CTCs. The CTCs count was significantly decreased compared with baseline in patients with different PD-L1 status CTCs at 1 week and 1 month after radiotherapy. The proportion of CD8+ T cells was significantly increased at 1 month after radiotherapy compared with baseline in the total population (mean change, 7.24 ± 2.12; P < .05) and patients with PD-L1 negative CTCs (mean change, 7.17 ± 2.65; P < .05). One month after radiotherapy, the proportion of CD8+ T cells was negatively correlated with the CTCs count in the total population (r = −0.255, P = .034) and PD-L1 negative patients (r = –0.330, P = .029). In patients with PD-L1 negative CTCs, the CTCs count 1 week after radiotherapy (hazard ratio, 0.150 [95% confidence intervals., 0.027–0.840], P = .031) and the proportion of CD8+ T cells 1 month after radiotherapy (hazard ratio, 7.961 [95% confidence intervals, 1.028–61.68], P = .047) were independent prognostic factors for disease recurrence.

After radiotherapy, only PD-L1-negative patients had a significant increase in the CD8+ T cell levels, while it was negatively correlated with CTCs count and was an independent prognostic factors of disease recurrence.
The long-term consequences of Corona Virus Disease 2019 patients receiving Chinese herbal medicine treatments in acute phase
Authors: Sun Yi-ming , Liu Jia-yan , Sun Ran , Zhang Jie , Xiao Meng-lu , Li Gui-ping
Published: August 2021

Background:

In December 2019, the first case of Corona Virus Disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus-2 viral infection was described in Wuhan. Similar to SARS in 2003, COVID-19 also had a lasting impact. Approximately 76% of patients discharged after hospitalization for COVID-19 had neurological manifestations which could persist for 6 months, and some long-term consequences such as the gradual loss of lung function due to pulmonary interstitial fibrosis could have comprehensive effects on daily quality of life for people who were initially believed to have recovered from COVID-19.

Methods and analysis:

Our comprehensive search strategy developed in consultation with a research librarian. We will search these following electronic databases: PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, Google Scholar, Embase, ProQuest, China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure, WANFANG DATA, WHO covid-19 website, and Centers for Disease Control and the Prevention COVID-19 websites of the United States and China. The bias of publication will be confirmed via the P value of Egger test. The quality of studies will be evaluated by the Newcastle-Ottawa Scale.

Ethics and dissemination:

There are no ethical considerations associated with this study protocol for this systematic review which mainly focuses on the examination of secondary data. On completion of this analysis, we will prepare a manuscript for publication in a peer-reviewed medical journal.

PROSPERO registration number:

CRD42021258711.
Effect of the stellate ganglion block on symptoms of ulcerative colitis
Authors: Kim Young Shin , Song Jang Ho , Kim Young Jun , Lee Kyung Joo , Lee Sun Hee , Kim Na Eun
Published: August 2021

Rationale:

Chronic ulcerative colitis is an autoimmune disease in which epithelial injury continuously occurs in the colonic mucosa. While mesalazine (5-aminosalicylic acid) is used to treat ulcerative colitis, it can also cause liver failure, headaches, and abdominal pain; therefore, an alternative treatment is required. The purpose of this study was to evaluate the effectiveness of 80 stellate ganglion blocks in reducing pain and other symptoms in a patient with chronic ulcerative colitis.

Patient concerns:

A 54-year-old female patient with a history of ulcerative colitis was concerned with worsening symptoms, such as abdominal discomfort and bloody-mucous stools, over the past 3 years.

Diagnoses:

Oozing mucosal bleeding and a small amount of exudate were observed on colonoscopy; a diagnosis of ulcerative colitis was made upon histologic examination.

Interventions and outcomes:

A total of 80 stellate ganglion blocks were administered, after which the patient's symptom and pain level was decreased from 6 to 4 points on the numeric rating scale (11-point, 0 = no pain, 10 = worst pain imaginable). Improved clinical signs were observed on colonoscopy at a follow-up assessment.

Lessons:

The stellate ganglion block may be effective for the reduction of pain and other symptoms in patients with chronic ulcerative colitis.
Effect assessment of laparoscopy in combination with traditional Chinese medicine decoction in the treatment of endometriosis
Authors: Peng Jiahua , Wang Ruiqi , Ding Zhiling , Song Xin
Published: August 2021

Background:

Endometriosis (EMs) affects about 10% of women of childbearing age. It is defined as functional endometrial tissue appearing in other parts of the uterine cavity, manifested by varying degrees of pelvic pain and pelvic mass, etc. Therefore, to improve the therapeutic effect of endometriosis, we must constantly explore new ways to treat the disease. The purpose of this study is to evaluate the effectiveness and safety of the combined use of laparoscopy and traditional Chinese medicine in the treatment of patients with EMs.

Methods:

A systematic literature search will be conducted at China National Knowledge Infrastructure, WanFang databases, VIP, SinoMed, PubMed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to June 21, 2021. To ensure the comprehensiveness of the search, relevant references and conference literature are also included. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan software will be employed to perform data synthesis and statistical analysis.

Results:

The effectiveness and safety of laparoscopic surgery combined with traditional Chinese medicine decoction in the treatment of patients with EMs will be systematically evaluated.

Conclusion:

The results of this study will provide strong evidence for judging whether laparoscopy combined with traditional Chinese medicine decoction is an effective strategy for the treatment of patients with EMs.
Combination therapy of Tocilizumab and steroid for management of COVID-19 associated cytokine release syndrome
Authors: Dravid Ameet , Kashiva Reema , Khan Zafer , Memon Danish , Kodre Aparna , Potdar Prashant , Mane Milind , Borse Rakesh , Pawar Vishal , Patil Dattatraya , Banerjee Debashis , Bhoite Kailas , Pharande Reshma , Kalyani Suraj , Raut Prathamesh , Bapte Madhura , Mehta Anshul , Reddy M. Sateesh , Bhayani Krushnadas , Laxmi S. S. , Vishnu P. D. , Srivastava Shipra , Khandelwal Shubham , More Sailee , Shinde Rohit , Pawar Mohit , Harshe Amol , Kadam Sagar , Mahajan Uma , Joshi Gaurav , Mane Dilip
Published: August 2021

Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.

This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.

Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.

Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.
Brimonidine related acute follicular conjunctivitis
Authors: Yeh Po-Han , Cheng Yu-Chun , Shie Shian-Sen , Lee Yung-Sung , Shen Su-Chin , Chen Henry Shen-Lih , Wu Wei-Chi , Su Wei-Wen
Published: August 2021

To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.

We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.

292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60–120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.

Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.
Investigating the correlation between serum albumin level and the prognosis of Bell's palsy
Authors: Shang Wenfang , Hu Haiyu , Shen Mengxia , Wu Jiangxia , Yu Zelin , Xuan Lihua
Published: August 2021

To investigate the correlation between the serum albumin level and the prognosis of patients with Bell's palsy.

We retrospectively analyzed the clinical records of 311 inpatients with Bell's palsy (BP) in our hospital between September 2018 and October 2019. The patients were divided into 2 groups: the recovered group (with the House-Brackmann grade ≤ 2) and the unrecovered group (with the House-Brackmann grade > 2), according to the follow-up results within 3 months after discharge. Blood test indicators (white blood cell count, neutrophil-to-lymphocyte ratio, red cell distribution width, serum albumin level, globulin level) and basic clinical data (age, sex, course of the disease, inpatient days, comorbidity of hypertension, diabetes, and hepatitis B) of the 2 groups were compared to explore whether they were correlated with the prognosis of patients with Bell's palsy.

The serum albumin level of patients with BP in the unrecovered group was significantly lower than that of the recovered group (medians [interquartile range], 40.75 [38.40, 43.85] vs 44 [42.10, 46.20], P < .001). Multivariate binary logistic regression revealed that serum albumin (odds ratio 0.772, 95% confidence interval 0.711–0.839, P < .001) was a protective factor for BP prognosis.

Serum albumin is a protective factor for the prognosis of BP. Although more prospective clinical controlled trials are needed, our study provides valuable and crucial prognostic information for physicians.
Association of gastroesophageal reflux disease with increased risk of chronic otitis media with effusion in adults
Authors: Yeo Cha Dong , Kim Jong Seung , Lee Eun Jung
Published: August 2021

This study aimed to evaluate the risk of developing chronic otitis media with effusion (OME) in individuals with gastroesophageal reflux disease (GERD).

A retrospective propensity score-matched cohort study was performed using data from the Korea National Health Insurance Service. The GERD group (n = 3532) included certain individuals who had been diagnosed with GERD between January 2002 and December 2005. A comparison control group (n = 14,128) was calculated by 1:4 Propensity Score (PS) matching considering age, sex, and comorbidities and year of enrolment. Each patient was monitored until 2013. Survival analysis, the log-rank test, and Cox proportional hazard regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of chronic OME for each group.

Among the 17,660 individuals included in the study population (53.2% male), the overall incidence of chronic OME during the 11-year follow-up was 1.84-fold higher in the GERD group than in the non-GERD group (1.8 vs 3.0 per 1000 person-year; adjusted HR 1.84; 95% confidence interval [CI], 1.46–2.31). Moreover, the adjusted HRs of developing chronic OME (allergic rhinitis, 1.69 [95% CI, 1.37–2.10]; asthma, 1.29 [95% CI, 1.02–1.64]; chronic rhinosinusitis, 1.61 [95% CI, 1.26–2.05]) were greater in study population with comorbidities.

From long-term follow-up, the prevalence of chronic OME in adults was 1.84 times higher in the GERD group compared with the non-GERD group. Specifically, it found that allergic rhinitis, asthma, or chronic rhinosinusitis showed increase the risk of developing chronic OME than those without these conditions.
A retrospective cohort study of disease-related risk factors for central venous catheter-related symptomatic thrombosis in intensive care unit inpatients
Authors: Kuang Zhiming , Liu Xiaochun , Zhu Yunlin , Xie Hailiang , Liu Yuanfei
Published: August 2021

Central venous catheters (CVC) are widely used in critically ill patients given their benefits in monitoring vital signs, treatment administration, and renal replacement therapy in intensive care unit (ICU) patients, but these catheters have the potential to induce symptomatic catheter-related venous thrombosis (CRVT). This study reported the rate of symptomatic CRVT in ICU patients receiving CVC and analyzed the disease-related risk factors for symptomatic CRVT in ICU patients.

A retrospective analysis was performed on the consecutive ICU 1643 critically ill patients with CVCs inserted from January 2015 to December 2019. Symptomatic CRVT was confirmed by ultrasound. CVCs were divided into 2 groups based on the presence of symptomatic CRVT, and the variables were extracted from the electronic medical record system. Logistic univariate and multivariate regression analyses were used to determine the disease-related risk factors of symptomatic CRVT.

A total of 209 symptomatic CRVT events occurred among 2114 catheters. The rate of CRVT was 9.5 per 1000 catheter days. Univariate analysis revealed that trauma, major surgery, heart failure, respiratory failure, and severe acute pancreatitis were risk factors for symptomatic CRVT in the ICU. Multivariate analysis showed that trauma (odds ratio [OR], 2.046; 95% confidence interval [CI] [1.325–3.160], P = .001), major surgery (OR, 2.457; 95% CI [1.641–3.679], P = .000), and heart failure (OR, 2.087; 95% CI [1.401–3.111], P = .000) were independent disease-related risk factors for symptomatic CRVT in ICU. The C-statistic for this model was 0.61 (95% CI [0.57–0.65], P = .000).

The incidence rate of symptomatic CRVT in the ICU population was 9.5 per 1000 catheter days. Trauma, major surgery, and heart failure are independent disease-related risk factors of symptomatic CRVT.
Cyclophosphamide induction dose and outcomes in ANCA-associated vasculitis with renal involvement
Authors: Speer Claudius , Altenmüller-Walther Christine , Splitthoff Jan , Nusshag Christian , Kälble Florian , Reichel Paula , Morath Christian , Zeier Martin , Bergner Raoul , Schaier Matthias
Published: August 2021

Treatment of ANCA-associated vasculitis (AAV) improved over the last decades but disease-unspecific agents such as cyclophosphamide are still associated with serious adverse events, including high rates of infectious complications and malignancy with increased mortality.

In this comparative cohort study, we included 121 AAV patients with renal involvement from 2 German vasculitis centers. Patients were separated into subsequent groups: 2.5 to 3 g vs >3 g cumulative cyclophosphamide induction dose. We investigated if a cyclophosphamide induction dose of 2.5 to 3 g could maintain efficacy while minimizing adverse events in AAV patients with renal involvement.

Patients with 2.5 to 3 g vs >3 g cumulative cyclophosphamide (median 3.0 g vs 5.5 g, P < .001) had a comparable time to remission (median 4.0 vs 3.8 months, log-rank P = .87) with 90.6% and 91.5% achieving remission after 12 months. Refractory disease was low in both groups (median 3.6% vs 6.2%, P = .68) and relapse rate did not differ (median 36% vs 42%, log-rank P = .51). Kidney function was comparable at disease onset in both groups (eGFR, mean ± SD 29 ± 20 mL/min/1.73 m2 vs 35 ± 26 mL/min/1.73 m2, P = .34) and improved after 2 years irrespective of the cyclophosphamide dose (ΔeGFR, mean ± SD +8.9 ± 1.4 mL/min/1.73 m2 vs +6.0 ± 1.1 mL/min/1.73 m2, P = .33). The 2.5–3 g group had a lower rate of leukopenia (HR = 2.73 [95% CI, 1.2−6.3], P = .014) and less infectious episodes per patient (median 1.2 vs 0.7, P = .012), especially urinary tract infections (HR = 2.15 [95% CI, 1.1–4.5], P = .032).

A cyclophosphamide induction dose of 2.5 to 3 g was able to induce remission and prevent from relapses with fewer cases of leukopenia and less infectious episodes during follow-up. Especially elderly AAV patients who are particularly susceptible to infectious complications could benefit from minimizing dosing regimens with maintained efficacy to control disease activity.
Retrospective review of cutaneous metastasis among 11,418 patients with solid malignancy
Authors: Teyateeti Phurichaya , Ungtrakul Teerapat
Published: August 2021

Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand.

We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome.

Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75–83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613).

Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients’ treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.
The real experience of patients after liver transplantation in intensive care unit: Retraction
Authors: Shi XR , Yang XY , Zhong J. , Luo WX , Yao JM , Lian RL , Chen WQ
Published: August 2021

We aimed to explore the real experience of patients after liver transplantation in the intensive care unit (ICU).

Objective sampling method was used to select patients transferred to the ICU in 10 hospitals in Zhuhai from May 2018 to August 2020. Patients need liver transplantation due to advanced liver cancer and decompensated cirrhosis. The eligibility criteria of patients mainly included liver transplant patients who were clear-minded and willing to participate in the study and had stayed in ICU. Phenomenological research methods and in-depth interviews were used in this qualitative study.

The results showed that the true experience of patients after liver transplantation during ICU stay was summarized into four themes. The strengths of our qualitative research are that we can find the trend from a phenomenon through interviews and other methods to provide a directional foundation for future quantitative research. Its limitations are that it requires a lot of manpower and time, and its objectivity and universality are limited.

Hospitalization experience in the ICU may lead to many negative experiences for liver transplant patients. Nurses should fully understand and pay attention to the psychological changes in patients. Nurses should take effective targeted measures to reduce or eliminate patients’ fear of ICU stay and promote rehabilitation.
Hereditary Angioedema Post-liver Transplant
Authors: Al Rawahi Yusriya , Wong Melanie , Stormon Michael
Published: August 2021

Liver transplantation is the standard of care in managing different types of liver disorders as well as a variety of inborn errors of metabolism. In the latter scenario, the liver-based enzyme abnormality is corrected by transplantation. Although rare, liver transplantation may result in the transmission of an inborn error of metabolism to the recipient. The present report describes the development of acquired hereditary angioedema likely following liver transplantation, with notable improvement with the initiation of C1 esterase inhibitor replacement therapy. This case report describes another example of a hepatic synthesis defect that, although rare, but can be acquired from donor’s livers.
Rapid antiretroviral therapy initiation and its effect on treatment response in MSM in West Africa
Authors: Dah Ter Tiero Elias , Yaya Issifou , Mensah Ephrem , Coulibaly Alou , Kouamé Jean-Baptiste Malan , Traoré Issa , Mora Marion , Palvadeau Paméla , Anoma Camille , Keita Bintou Dembélé , Spire Bruno , Laurent Christian
Published: August 2021

Objective:

To assess the time from HIV diagnosis to ART initiation and the effect of rapid ART initiation (i.e. within 7 days of HIV diagnosis) on attrition and virologic and immunologic responses among MSM in Burkina Faso, Côte d’Ivoire, Mali, and Togo.

Design:

Prospective cohort study between 2015 and 2019.

Methods:

MSM aged 18 years or older newly diagnosed with HIV infection were eligible to participate. ART was proposed to participants upon HIV diagnosis, irrespective of clinical stage and CD4+ cell count, and was initiated as soon as possible, with no specific time frame. Determinants of rapid ART initiation and its effect on treatment outcomes were assessed using multivariate analyses.

Results:

Of 350 MSM, 335 (95.7%) initiated ART after a median time of 5 days. Of the latter, 216 (64.5%) had rapid ART initiation. The 335 participants were followed up for a median time of 24.1 months. One hundred and eleven (33.1%) were not retained in care. Rapid ART initiation was less likely in participants with a CD4+ cell count at least 200 cells/μl [adjusted odds ratio (aOR) 0.37, 95% confidence interval (CI) 0.15–0.88]. It improved viral load suppression (aOR 6.96, 95% CI 1.98–24.46) but had no effect on attrition (aOR 0.87, 95% CI 0.57–1.33) or CD4+ cell count increase (adjusted coefficient 28.23, 95% CI −17.00 to 73.45).

Conclusion:

These results in MSM in West Africa support the WHO recommendation for rapid ART initiation. Clinics need to develop context-specific strategies for rapid ART initiation and for retaining MSM in HIV care.

ClinicalTrials.gov, number NCT02626286.
Artificial Intelligence in Chest Radiography Reporting Accuracy
Authors: Rudolph Jan , Huemmer Christian , Ghesu Florin-Cristian , Mansoor Awais , Preuhs Alexander , Fieselmann Andreas , Fink Nicola , Dinkel Julien , Koliogiannis Vanessa , Schwarze Vincent , Goller Sophia , Fischer Maximilian , Jörgens Maximilian , Ben Khaled Najib , Vishwanath Reddappagari Suryanarayana , Balachandran Abishek , Ingrisch Michael , Ricke Jens , Sabel Bastian Oliver , Rueckel Johannes
Published: August 2021

Objectives

Chest radiographs (CXRs) are commonly performed in emergency units (EUs), but the interpretation requires radiology experience. We developed an artificial intelligence (AI) system (precommercial) that aims to mimic board-certified radiologists' (BCRs') performance and can therefore support non–radiology residents (NRRs) in clinical settings lacking 24/7 radiology coverage. We validated by quantifying the clinical value of our AI system for radiology residents (RRs) and EU-experienced NRRs in a clinically representative EU setting.

Materials and Methods

A total of 563 EU CXRs were retrospectively assessed by 3 BCRs, 3 RRs, and 3 EU-experienced NRRs. Suspected pathologies (pleural effusion, pneumothorax, consolidations suspicious for pneumonia, lung lesions) were reported on a 5-step confidence scale (sum of 20,268 reported pathology suspicions [563 images × 9 readers × 4 pathologies]) separately by every involved reader. Board-certified radiologists' confidence scores were converted into 4 binary reference standards (RFSs) of different sensitivities. The RRs' and NRRs' performances were statistically compared with our AI system (trained on nonpublic data from different clinical sites) based on receiver operating characteristics (ROCs) and operating point metrics approximated to the maximum sum of sensitivity and specificity (Youden statistics).

Results

The NRRs lose diagnostic accuracy to RRs with increasingly sensitive BCRs' RFSs for all considered pathologies. Based on our external validation data set, the AI system/NRRs' consensus mimicked the most sensitive BCRs' RFSs with areas under ROC of 0.940/0.837 (pneumothorax), 0.953/0.823 (pleural effusion), and 0.883/0.747 (lung lesions), which were comparable to experienced RRs and significantly overcomes EU-experienced NRRs' diagnostic performance. For consolidation detection, the AI system performed on the NRRs' consensus level (and overcomes each individual NRR) with an area under ROC of 0.847 referenced to the BCRs' most sensitive RFS.

Conclusions

Our AI system matched RRs' performance, meanwhile significantly outperformed NRRs' diagnostic accuracy for most of considered CXR pathologies (pneumothorax, pleural effusion, and lung lesions) and therefore might serve as clinical decision support for NRRs.
Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study
Authors: Herdman M. Trent , Karo Basel , Dave Jayshree , Katwa Parisha , Freedman Joanne , Do Nascimento Vivienne , Kirkbride Hilary , Chattaway Marie Anne , Godbole Gauri , Balasegaram Sooria
Published: August 2021

Introduction. Enteric fever (caused by

Salmonella enterica

serovars Typhi and Paratyphi) frequently presents as an acute, undifferentiated febrile illness in returning travellers, requiring timely empirical antibiotics.

Gap Statement. Determining which empirical antibiotics to prescribe for enteric fever requires up-to-date knowledge of susceptibility patterns.

Aim. By characterising factors associated with antimicrobial resistance in cases of S. Typhi and S. Paratyphi imported to England, we aim to guide effective empirical treatment.

Methodology. All English isolates of S. Typhi and S. Paratyphi 2014–2019 underwent antimicrobial susceptibility testing; results were compared to a previous survey in London 2005–2012. Risk factors for antimicrobial resistance were analysed with logistic regression models to predict adjusted odds ratios (aOR) for resistance to individual antibiotics and multi-drug resistance.

Results. We identified 1088 cases of S. Typhi, 729 S. Paratyphi A, 93 S. Paratyphi B, and one S. Paratyphi C. In total, 93 % were imported. Overall, 90 % of S. Typhi and 97 % of S. Paratyphi A isolates were resistant to ciprofloxacin; 26 % of S. Typhi were multidrug resistant to ciprofloxacin, amoxicillin, co-trimoxazole, and chloramphenicol (MDR+FQ). Of the isolates, 4 % of S. Typhi showed an extended drug resistance (XDR) phenotype of MDR+FQ plus resistance to third-generation cephalosporins, with cases of XDR rising sharply in recent years (none before 2017, one in 2017, six in 2018, 32 in 2019). For S. Typhi isolates, resistance to ciprofloxacin was associated with travel to Pakistan (aOR=32.0, 95 % CI: 15.4–66.4), India (aOR=21.8, 95 % CI: 11.6–41.2), and Bangladesh (aOR=6.2, 95 % CI: 2.8–13.6) compared to travel elsewhere, after adjusting for rising prevalence of resistance over time. MDR+FQ resistance in S. Typhi isolates was associated with travel to Pakistan (aOR=3.5, 95 % CI: 2.4–5.2) and less likely with travel to India (aOR=0.07, 95 % CI 0.04–0.15) compared to travel elsewhere. All XDR cases were imported from Pakistan. No isolate was resistant to azithromycin. Comparison with the 2005–2012 London survey indicates substantial increases in the prevalence of resistance of S. Typhi isolates to ciprofloxacin associated with travel to Pakistan (from 79–98 %) and Africa (from 12–60 %).

Conclusion. Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.
Oral probiotic and its delivery carriers to improve oral health: A review
Authors: How Yu-Hsuan , Yeo Siok-Koon
Published: August 2021

In recent years, oral probiotics have been researched on their effectiveness in reducing and preventing oral diseases. Oral probiotics could be introduced into the oral cavity to keep the equilibrium of the microbiome. Hence, the delivery carrier for oral probiotics plays an important factor to ensure a high number of oral probiotics were delivered and released into the oral cavity. This review presents a brief overview of oral microbiota and the role of oral probiotics in reducing oral diseases. Moreover, important aspects of the oral probiotic product such as viability, adherence ability, health effects, safety, and delivery site were discussed. Besides that, the importance of utilizing indigenous oral probiotics was also emphasized. Oral probiotics are commonly found in the market in the form of chewing tablets, lozenges, and capsules. Hence, the oral probiotic carriers currently used in the market and research were reviewed. Furthermore, this review introduces new potential oral probiotic delivery carriers such as oral strip, bucco-adhesive gel, and mouthwash. Their effectiveness in delivering oral probiotics for oral health was also explored.