bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Appropriateness of Antipsychotic Prescribing in an Italian Prison
Authors: Pelizza Lorenzo , Maestri Davide , Paulillo Giuseppina , Pellegrini Pietro
Published: December 2021

Purpose/Background

Although the prevalence of mental disorders in prisoners is known to be higher than in the general population, less is known about the antipsychotic (AP) prescribing rate in jail. The aim of this research was to investigate prevalence and appropriateness of AP prescription in an Italian prison to expand our understanding on this crucial area of clinical-forensic practice.

Methods/Procedures

A cross-sectional (census day) design was used among male adults in the Parma Penitentiary Institutes (PPI). Sociodemographic, clinical and prescription data were collected from the PPI electronic clinical database management system. The AP prescribing appropriateness was examined in accordance with the therapeutic indications included in the Italian National Formulary. A descriptive statistical analysis was performed.

Findings/Results

A total of 98 (14.1%) of 696 PPI prisoners were taking AP medications. Moreover, 90 (91.8%) of the 98 PPI participants were also taking other psychotropic medications concurrently. Quetiapine and olanzapine were the most common prescribed APs. Antipsychotic medications were most likely to be prescribed for off-label indications (74.4%). Less than one fifth of all AP prescriptions were for psychotic disorders.

Implications/Conclusions

Antipsychotic medications are widely used in prison, often together with other psychotropic drugs. Considering their common adverse effects, it is crucial to longitudinally monitor their potential risk of metabolic, cardiovascular, and extrapyramidal symptoms and signs, as well as their early risk of mortality. Given the high prevalence of AP off-label prescription, the rationale for AP prescribing should be clearly documented and regularly reviewed within the prison by mental health professionals.
Scheme optimization of acupoints compatibility and influence factors of the effect
Authors: Ha Lijuan , Liu Xiaona , Liu Yanze , Zhi Mujun , Jiang Hailin , Zhao Jingying , Wang Yiming , Xu Xiaoru , Guo Le , Cao Jiazhen , Chen Liyuan , Yuan Yue , Li Tie , Wang Fuchun
Published: December 2021

Background:

Acupuncture may be a clinically effective treatment for insomnia. We will perform a multicenter, large-scale, single-blinded, randomized controlled trial to compare the differences in the clinical efficacy between the use of singleacupoints and compatibilityacupoints in the treatment of primary insomnia.

Methods/Design:

A total of 333 participants will be randomly assigned to 2 acupoint treatment groups or 1 nonacupoint control group in a 1:1:1 ratio by a central stochastic system. The acupuncture groups are: the single acupoint group: Shenmen (HT7); and he compatibility acupoint group: Shenmen (HT7), Baihui (DU20), and Sanyinjiao (SP6). The observation period of this trial will be 10 weeks. All patients will be followed for 1 week before randomization (baseline phase). After randomization, the patients will receive 30 minutes of electro-acupuncture once per day for 5 weeks. In the fourth week after the treatment, follow-up will be performed once. The primary outcome will be the Pittsburgh sleep quality index score at 1 week before randomization and 2 and 8 weeks after randomization. The secondary outcomes will include data from sleep diaries, Athens insomnia scale scores, ShortForm-36 Health Survey scores, electroencephalogram technology results and polysomnogram) results. Patients will be required to complete a sleep diary every day during the treatment period. Patients will also undergo electroencephalogram technology and polysomnogram 1 week before randomization and 5 weeks after randomization. The other secondary outcomes will be measured 1 week before randomization and 5 and 9 weeks after randomization.

Discussion:

This trial will be helpful in identifying whether acupuncture at compatibility acupoints is more effective than acupuncture at single acupoints.

Trial registration:

Clinical Trials.govNCT02448602, Registered 5May 2015, https://www.clinicaltrials.gov/ct2/show/NCT02448602?term=NCT02448602&rank=1
Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of early prostate cancer among men who underwent robotic transperineal prostate biopsy
Authors: Du Jingzeng , Lim Ee Jean , Huang Hong Hong , Lau Weber Kam On
Published: December 2021

To evaluate the predicted value of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of early prostate cancer by using standardized Full blood count (FBC) performed within 4 weeks before biopsy and histology results from transperineal prostate biopsy (RTPB).

Patients who underwent RTPB under general anesthesia (GA), at Urology Department, Singapore General Hospital between September 2006 and Febuary 2016 were retrospectively reviewed.

NLR was calculated using full blood count (FBC) that was done as a pre-admission test before GA within 4 weeks before the biopsy. Statistical analyses were done to establish the correlation of NLR and different clinical parameters such as biopsy histology, pre-biopsy PSA, and prostate volume.

A total of 652 patients who underwent RTPB for diagnostic purposes with a valid PSA level were included in this study. There was total of 409 (62.7%) benign histology and 243 (37.3%) prostate cancer. There was no significant difference in median NLR between the benign and prostate cancer group (2.00 vs 1.99; P = .29).

In the subgroups analysis, there was also no significant difference of median NLR value in clinical significant cancer (defined as Gleason 3 + 4 and above) and benign histology group (NLR 2.00 vs 2.01, P = .41), as well as prostate cancer and benign group according to different pre-biopsy PSA levels: PSA (ug/l) < 4, 4 to 10, 10 to 20, and >20, respectively. (Median NLR 1.34 vs 1.76; 1.97 vs 1.97; 1.97 vs 2.18; 2.18 vs 1.98, P > .05). NLR is neither associated with prostate cancer using logestic regression model nor a strong predictor of the Gleason grade group and D’Amico risk stratification group using ordinal regression model. (P > .05)

There was no statistically significant difference of NLR between the benign and prostate cancer group as a whole or in the subgroup analyses for patients who underwent robotic transperineal prostate biopsy. NLR may have a limited role in predicting early-stage prostate cancer.
Spinocerebellar ataxia type 28 in a Chinese pedigree
Authors: Liu Xiaoyang , Wang Linlin , Chen Jiajun , Kang Chunyang , Li Jia
Published: December 2021

Rationale:

Spinocerebellar ataxia (SCA) is a common neurogenetic disease that mainly manifests as ataxia of posture, gait, and limbs, cerebellar dysarthria, and cerebellar and supranuclear eye movement disorders. SCA has been found to include many subtypes, which are mainly mapped to 2 genetic patterns: autosomal dominant cerebellar ataxia and autosomal recessive cerebellar ataxia. Molecular genetic diagnosis functions as a necessity in its clinical diagnosis and treatment. In preliminary clinical work, we identified a family of SCA28 with rare gene mutation.

Patient concerns:

There are 5 patients in this family. The proband is a 32 year-old male, he mainly manifest unsteady steps for more than 7 months. The daughter of his younger maternal uncle gradually had unsteady steps and unclear speech for 5 years. The proband's mother, uncle and grandfather had similar symptoms, but they all died.

Diagnosis:

After Brain magnetic resonance imaging, whole exome sequencing and Sanger validation, the patients presented a c.1852A > G missense mutation in the exon region of AFG3L2 gene. The other family members revealed no AFG3L2 mutations. SCA28 is the one uniquely caused by a pathogenic variation in the mitochondrial protein AFG3L2. Combined with the clinical manifestations, auxiliary examinations and sequencing results of the patients (III-3 and III-5), the diagnosis of SCA28 was suspected.

Interventions:

The patients did not receive any drug treatment and the proband receive rehabilitation treatment.

Outcomes:

The symptoms of ataxia were still progressively aggravated.

Lessons:

Molecular genetic diagnosis is necessary for ataxia. We here report the case and review the literature.
Longitudinal assessment of anxiety/depression rates and their related predictive factors in acute ischemic stroke patients
Authors: Liu Xin , Cheng Chunmei , Liu Zhaojun , Fan Wenjun , Liu Chunhua , Liu Yin
Published: December 2021

This study aimed at investigating the longitudinal changes of poststroke anxiety/depression rates, and their potential risk factors in acute ischemic stroke (AIS) patients.

A total of 250 first diagnosis of AIS patients were enrolled and followed for 36 months. Anxiety/depression of patients were assessed using hospital anxiety and depression scale (HADS) at month (M) 0 (M0) and then every 3 months till M36.

During 36-month follow-up, both HADS-anxiety score (from 6.9 ± 3.1 at M0 to 8.0 ± 3.5 at M36) and anxiety rate (from 41.2% at M0 to 54.0% at M36) (both P < .01) were increased with time longitudinally. Meanwhile, HADS-depression score (from 6.2 ± 3.0 at M0 to 6.9 ± 3.1 at M36) and depression rate (from 32.4% at M0 to 40.4% at M36) (both P > .05) displayed an upward trend with time longitudinally but without statistical significance. By forward multivariate logistic regression analysis, female, diabetes and higher National Institute of Health Stroke Scale (NIHSS) score independently predicted elevated anxiety risk at M0, M12, M24, and M36 (all P < .05); while longer education duration and hypertension independently predicted raised anxiety risk at M0 and M12 (all P < .05), respectively. Regarding depression, diabetes independently predicted increased depression risk at M0, M12, M24, and M36 (all P < .01); longer education duration independently predicted higher depression risk at M0 and M12 (both P < .05); female independently predicted increased depression risk at M24 and M36 (both P < .01); higher NIHSS score independently predicted raised depression risk at M24 and M36 (both P < .01).

Poststroke anxiety and depression are frequent, which deteriorate with time; besides, female, diabetes, NIHSS score, hypertension and education duration independently predicted increased poststroke anxiety or depression risk in AIS patients.
The application effect of internet technology on managing patients with hypertension in a medical center
Authors: Yin Bai-Ding , Tu Da-Hong , Yang Nuo , Wang Jing
Published: December 2021

Objectives:

This study aimed to investigate the application effect of internet technology for managing patients with hypertension in a medical center.

Methods:

From December 2017 to December 2018, 400 patients with hypertension in two community health service stations affiliated to Beijing Shijitan Hospital (China) were enrolled in the present study. According to the alternating method, these patients were divided into a control group (routine medical hypertension management) and an e-intervention group (internet technical secondary hypertension management). Blood pressure levels after intervention in both groups, as well as blood pressure control, medication compliance, active health behaviors, and two-way referral rate were observed.

Results:

Following the interventions, blood pressure levels were significantly lower in the e-intervention group compared with the control group, and the proportion of good blood pressure control, medication compliance, active health behavior, and two-way referral were all significantly higher compared with the control group.

Conclusion:

The application of internet technology in medical associations may help to decrease patients’ blood pressure and improve the effective management of middle-aged and older patients with hypertension in communities.
Ultrafiltration for patients with acute decompensated heart failure
Authors: Wang Meng-jun , Zheng Yan-mei , Jin Hong-xu
Published: December 2021

Background:

Ultrafiltration plays an indispensable role in relieving congestion and fluid retention in patients with acute decompensated heart failure (ADHF) in recent years. So far, there is no consistent agreement about whether early ultrafiltration (UF) is a first-line treatment for patients with ADHF. We, therefore, conducted a meta-analysis to assess the efficacy and safety of UF.

Methods:

PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that compared UF with diuretics in patients with ADHF and included our interested outcomes. The primary outcomes are heart failure rehospitalization, all-cause rehospitalization, and mortality. The second outcomes are fluid loss, weight loss, and adverse events. RevMan Version 5.4.1 was used to analyze the data of included studies.

Results:

A total of 12 studies with 1197 patients were included. Our results showed a reduction in heart failure rehospitalization (risk ratio [RR] 0.67, 95% confidence interval [CI]: 0.52–0.87, P = .003) and all-cause rehospitalization (RR 0.62, 95% CI: 0.42–0.92; P = .02), an increase in fluid loss (1.47 L, 95% CI: 0.95–1.99 L, P < .001) and weight loss (1.65 kg, 95% CI: 0.90–2.41 kg; P < .001). There was no difference in mortality (RR 1.09, 95% CI: 0.78–1.51; P = .62). There were inconsistent agreements about which group have more total adverse events. Subgroup analysis showed that UF with larger mean fluid-remove rate (≥200 mL/h) could significantly remove more fluid, lose more weight, and decrease heart failure rehospitalization. Less weight loss for patients with ADHF may correlated to higher percent of ischemic etiology (ischemic etiology ≥50%).

Conclusion:

Although UF is more effective in removing fluid than diuretics and decrease rehospitalization of heart failure and all causes, there is not enough evidence to prove that UF is superior because of adverse events and mortality in the UF group. The mean fluid-removal rates should be set to ≥200 mL/h. Patient with different etiology may have different effects when treated with UF and it is a weak conclusion.

Trial registration: The systematic review was registered with the International Prospective Registry of Systematic Reviews. (https://www.crd.york.ac.uk/prospero/, registration number CRD42021245049).
The therapeutic efficacy and safety of traditional Chinese medicine injection combined with low-molecular-weight heparin on the acute lower extremity deep venous thrombosis
Authors: Zeng Mulan , Liao Qian , Cui Yinjie , Tang Hongbo , Yu Maowen
Published: December 2021

Background:

Lower extremity deep venous thrombosis (LEDVT) of lower extremities is one of the common clinical diseases. Lack of a timely treatment in the acute stage easily causes pulmonary embolism, thus seriously threatening patients’ life. Low-molecular-weight heparin (LMWH), as a new generation of heparin-based anticoagulant and antithrombotic drug, is now commonly used in the clinical treatment of acute lower extremity deep venous thrombosis (ALEDVT). Relevant randomized controlled trials (RCTs) have reported the therapeutic efficacy and safety of Traditional Chinese medicine injection (TCMJ) combined with LMWH on ALDVT, although their conclusions remain controversial. In addition, the efficacy of various TCMJs has rarely been analyzed and compared. This study aims to evaluate the therapeutic efficacy and safety of TCMJ combined with LMWH on ALEDVT through a network meta-analysis.

Methods:

RCTs reporting TCMJ combined with LMWH and LMWH along for the treatment of ALEDVT published before November 2021 will be searched in online databases, including the Cochrane Library, Embase, PubMed, Web of Science, Wanfang, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biomedical Literature Database, and Chinese National Knowledge Infrastructure. Two investigators will be independently responsible for literature screening, data extraction, and quality evaluation according to Cochrane's risk of bias assessment tool. R software will be used to perform a network Meta-analysis.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide high-quality, evidence-based medical evidence for comparing the therapeutic efficacy and safety of TCMJ combined with LMWH and LMWH alone on ALEDVT.
Prenatal diagnosis of chromosome 18 long arm deletion syndrome by high-throughput sequencing
Authors: Bai Xuechun , Zheng Lianwen , Ma Shuai , Kan Xun
Published: December 2021

Rationale:

Chromosome 18 long arm deletion syndrome is a group of clinical syndromes caused by partial or total genetic material deletion of the long arm of chromosome 18 (18q), whose clinical manifestations are related to presentation and developmental abnormalities in various aspects such as intelligence, face, and movement. Prenatal diagnosis of this syndrome is challenging because of its low incidence and uncharacteristic prenatal clinical performance. In this paper, 2 cases of partial deletion of 18q found in prenatal amniotic fluid examination by high-throughput sequencing were reported and analyzed.

Patient concerns:

In patient 1, non-invasive prenatal gene detection at 21 + 2 weeks of gestation suggests a risk of trisomy 18. In patient 2, ultrasound examination at 21 + 2 weeks of gestation revealed a single live fetus, but it was difficult to pinpoint whether the fetus had only 1 umbilical artery to supply blood.

Diagnosis and intervention:

The 18q deletion syndrome was diagnosed by chromosome karyotype analysis and high-throughput sequencing.

Outcomes:

The pregnancies were terminated due to the abnormal chromosome.

Lesson:

This report adds novel variants to the genetic profile of 18q deletion, in order to enrich the genetic data of long arm deletion of 18 chromosomes and provide better services for pre-screening, diagnosis, and genetic counseling for this disease.
Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma for adults
Authors: Ko Hung-Ju , Lin Ying-Chun , Chen Chieh-Chang , Chen Ming-Jen , Wu Ming-Shiang , Liu Chun-Jen , Huang Chun-Ta , Yang Horng-Woei , Shih Shou-Chuan , Yu Lo-Yip , Kuo Yang-Che , Wang Horng-Yuan , Hu Kuang-Chun
Published: December 2021

Background:

Helicobacter pylori infection and hyperglycemia are associated with an increased risk of colorectal neoplasm, and may have a synergistic effect in combination. However, these 2 factors that affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H pylori infection rate with colorectal adenoma risk for adults.

Methods:

We conducted systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence <6% (Group 1); between 6% and 8% (Group 2); between 8% and 10% (Group 3), and more than 10% (Group 4). The random-effects model had used to calculate pooled prevalence estimates with 95% confidence interval (CI).

Results:

Twenty-seven studies were finally eligible for meta-analysis. The random-effects model of the meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As the diabetes rate exceed 6%, the H pylori infection became the more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); and Group 4: OR 1.52 (95% CI 1.46–1.57)).

Conclusions:

The results of this meta-analysis showed elevated diabetes prevalence combined H pylori infection increasing the risks of colorectal adenoma in the adult population.
Clinical and sociodemographic determinants of disease progression in patients with nonalcoholic steatohepatitis in the United States
Authors: Ruiz-Casas Leonardo , Pedra Gabriel , Shaikh Anum , Franks Bethany , Dhillon Harpal , Fernandes João Diogo da Rocha , Mangla Kamal Kant , Augusto Margarida , Schattenberg Jörn M. , Romero-Gómez Manuel
Published: December 2021

One fifth of patients with nonalcoholic fatty liver disease (NAFLD) may progress to nonalcoholic steatohepatitis (NASH), which can increase the risk of cirrhosis, cancer, and death. To date, reported predictors of NASH progression have been heterogeneous.

We identified determinants of fibrosis progression in patients with NASH in the United States using physician-reported data from the real-world Global Assessment of the Impact of NASH (GAIN) study, including demographics and clinical characteristics, NASH diagnostic information, fibrosis stage, comorbidities, and treatment. We developed a logistic regression model to assess the likelihood of fibrosis progression since diagnosis, controlling for sociodemographic and clinical variables. An iterative nested model selection approach using likelihood ratio test determined the final model.

A total of 989 patients from the GAIN US cohort were included; 46% were women, 58% had biopsy-proven NAFLD, and 74% had fibrosis stage F0–F2 at diagnosis. The final multivariable model included age, years since diagnosis, sex, employment status, smoking status, obesity, fibrosis stage, diagnostic biopsy, Vitamin E, and liver transplant proposed at diagnosis. Odds of progression were 17% higher (odds ratio, 1.17 [95% CI: 1.11–1.23]; P < .001) with each year since NASH diagnosis, 41% lower (0.59 [0.38–0.90]; P = .016) for women than men, 131% higher (2.31 [1.30–4.03]; P = .004) for smokers versus non-smokers, and 89% higher (1.89 [1.26–2.86]; P = .002) with obesity. Odds of progression were also higher with part-time, retired, unemployed, and unable to work due to NASH status versus full-time employment, and when a liver transplant was proposed at diagnosis.

Disease duration and severity, obesity, smoking, and lack of full-time employment were significant determinants of fibrosis progression. These findings can support clinical and health-policy decisions to improve NASH management in the US.
Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery
Authors: Zhang Tianyao , Wu Xiaochu , Zhang Yu , Zeng Lin , Liu Bin
Published: December 2021

Background:

Atrial fibrillation is the main complication of patients who suffer from valvular heart disease (VHD), which may lead to an increased susceptibility to ventricular tachycardia, atrial dysfunction, heart failure, and stroke. Therefore, seeking a safe and effective therapy is crucial in prolonging the lives of patients with VHD and improving their quality of life.

Methods:

Our target database included PubMed, Web of Science, Embase, and Cochrane Library, from which published articles were retrieved from inception to June 2020. We retrieved all randomized controlled trials (RCTs) that compared patients undergoing valve surgery with (VSA) or without ablation (VS) procedure. Studies to be included were screened and data extraction was performed independently by 2 investigators. The Cochrane risk-of-bias table was used to evaluate the methodological quality of the included RCTs. The mean difference (MD) with 95% confidence interval (CI) and relative risk (RR) ratio was calculated to analyze the data. Heterogeneity was evaluated using I2 and chi-square tests. Egger test and the trim and fill analysis were used to further determine publication bias.

Results:

Fourteen RCTs that included 1376 patients were eventually selected for this meta-analysis. Surgical ablation was found to be effective in restoring sinus rhythm in valvular surgery patients at discharge (RR 2.91, 95% CI [1.17, 7.20], I2 97%, P = .02), 3 to 6 months (RR 2.85, 95% CI [2.27, 3.58], I2 49%, P < .00001), 12 months, and more than 1 year after surgery (RR 3.54, 95% CI [2.78, 4.51], I2 27%, P < .00001). All-cause mortality (RR 0.98, 95% CI [0.64, 1.51], I2 0%, P = .94) and stroke (RR 1.29, 95% CI [0.70, 2.39], I2 0%, P = .57) were similar in the VSA and VS groups. Compared with VS, VSA prolonged cardiopulmonary bypass time (MD 30.44, 95% CI [17.55, 43.33], I2 88%, P < .00001) and aortic cross-clamping time (MD 19.57, 95% CI [11.10, 28.03], I2 89%, P < .00001). No significant differences were found between groups with respect to the risk of bleeding (RR 0.64, 95% CI [0.37, 1.12], I2 0%, P = .12), heart failure (RR 1.11, 95% CI [0.63, 1.93], I2 0%, P = .72), and low cardiac output syndrome (RR 1.41, 95% CI [0.57, 3.46], I2 18%, P = .46). However, the demand for implantation of a permanent pacemaker was significantly higher in the VSA group (RR 1.84, 95% CI [1.15, 2.95], I2 0%, P = .01).

Conclusion:

Although we found high heterogeneity in the restoration of sinus rhythm at discharge, we assume that the comparison is valid at this time, given the current state in the operating room. This study provides evidence of the efficacy and security of concomitant ablation intervention for patients with VHD and atrial fibrillation. Surgical ablation would increase the safety of implantation of a permanent pacemaker in the population that underwent valve surgery.
Efficacy and safety of Shumian capsules in treating insomnia
Authors: Wang Cuiying , Yang Yuying , Ding Xiao , Li Jiamin , Zhou Xue , Teng Jing , Qi Xianghua
Published: December 2021

Background:

It is known to all that the incidence of insomnia is becoming higher and higher with the increase of people's life stress. To some extent, it has brought about bad effects on people's life, work, study, and health, such as mental exhaustion, low work efficiency, and mood irritability. Now there are medications and non-medications methods for insomnia. As one of the treatments for insomnia, western medicine is to prolong the sleeping time and improve the anxious mood. However, taking western medicine to treat insomnia can also be accompanied by some adverse reactions at the same time, such as drug dependence, an allergic reaction, and so on. Traditional Chinese medicine therapy is based on syndrome differentiation and holistic concept. Shumian capsules (SM) are a kind of proprietary Chinese medicine for insomnia, which have the effect of relieving depression and calming the mind. But there are no studies on the efficacy and safety of SM in the treatment of insomnia. Therefore, I will provide a systematic review and meta-analysis to evaluate the efficacy and safety of SM for insomnia.

Methods:

All the studies searched were from PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang databases, and the studies types included in the analysis were all randomized controlled trials. All the retrieval contents were completed independently by 2 researchers, and a third reviewer would be involved when there existed any disagreement. The eligible studies were screened out according to the inclusion criteria and exclusion criteria, and some useful information was extracted and made into a feature table, including the year of the included studies, the age, and disease course of the participants in the studies and intervention methods, etc. Cochrane risk-of-bias tool was used to evaluate the quality of literature and meta-analysis was conducted by RevMan 5.4 software.

Results:

A total of 9 articles including 709 participants were included in the study after screening out. The primary outcomes of statistical analysis were cure rate and total effective rate, while the secondary outcomes included Pittsburgh sleep quality index score and incidence of adverse reactions. The results showed that Pittsburgh sleep quality index score of the SM group and Western medicine group were statistically significant (MD = –0.50, 95% confidence interval [CI] = [–0.78, –0.22], P = .0005). The total effective rate of the SM group was slightly higher than that of the Western medicine group, but there was no statistical significance (relative risk [RR] = 1.03, 95% CI = [0.95,1.13], P = .43).

Conclusion:

This meta-analysis provides evidence for the efficacy and safety of SM in the treatment of insomnia, and provides a new idea for the clinical treatment of insomnia. But more research is needed to support further evidence.
The blood-brain barrier disruption after syncope: a dynamic contrast-enhanced magnetic resonance imaging study
Authors: Huh Hyungkyu , Lee Eun-Hee , Oh Sung Suk , Kim Jong-Hoon , Seo Young Beom , Choo Yoo Jin , Park Juyoung , Chang Min Cheol
Published: December 2021

Rationale:

Using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), we demonstrated blood-brain barrier (BBB) disruption following syncope.

Patient concerns:

A 45-year-old man experienced syncope with a chief complaint of syncope (duration: 1 minutes), 1 day before visiting a university hospital for examination. He had no history of medical problems and was not taking any medications. This episode was the first in his lifetime.

Diagnoses:

After syncope, the patient did not have any illnesses or symptoms, such as headache, cognitive deficits, or somnolence.

Interventions:

Cardiac evaluation did not reveal any abnormal findings. In addition, in conventional brain and chest computed tomography and brain MRI, no abnormal lesions were observed.

Outcomes:

DCE-MRI of the patient showed bright blue colored lines within the sulci throughout the cerebral cortex. The regions of interest, including bright blue colored lines, had significantly higher Ktrans values (6.86 times higher) than those in healthy control participants. These findings are indicative of BBB disruption of the vessels in the sulci.

Lessons:

Using DCE-MRI, we demonstrated BBB disruption following syncope. DCE-MRI is a useful tool for the detection of BBB disruption following syncope.
Efficacy, safety, and retention rate of extended-release divalproex versus conventional delayed-release divalproex
Authors: Zhang Chen Qi , Bai Xue Yang , Wan Yong , Li Hong Yan , Sun Hongbin
Published: December 2021

Background:

A novel once-daily divalproex-extended release (VPA-ER) dose formulation has been developed, which prolongs therapeutic serum levels compared with that of twice-daily conventional divalproex-delayed release (VPA-DR). Currently, there is lack of meta-analysis focusing on drug retention rate between VPA-ER and VPA-DR. Thus, our study is the first one that aims to systematically examine and compare the efficacy, safety, and retention rate of VPA-ER and VPA-DR.

Methods:

Online databases including MEDLINE via PubMed, Cochrane Library, Embase (up to October 30, 2021) will be applied for literature screen. We will conduct meta-analysis by using Stata16.0 software.

Results:

This study aims to evaluate the efficacy, safety, and drug retention rate of VPA-ER versus conventional VPA-DR

Conclusion:

Once-daily VPA-ER may present a positive efficacy and not increase the incidence of AEs and has a higher retention rate for patients, which can be used as a substitute for conventional VPA-DR.

INPLASY registration number: INPLASY2021110090

(DOI: 10.37766/inplasy2021.11.0090).
Outcomes of 2-octyl cyanoacrylate skin adhesives following musculoskeletal oncology surgery
Authors: Chobpenthai Thanapon , Poosiripinyo Thanate , Tuntarattanapong Pakjai , Thanindratarn Pichaya , Trathitephun Warayos
Published: December 2021

2-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal surgery.

We enrolled 99 patients who underwent musculoskeletal surgery. 2OCA was chosen for wound closure and was performed by a specific surgeon for all patients. The drying times for the adhesive were recorded, and photographs were obtained intra-operatively. Posttreatment follow-up consisted of queries regarding pain level and recording incisional dehiscence, wound infection, hematoma, and incisional bleeding. Data collection was performed postoperatively at 48 hours, 5 to 10 days, 14 days, and 30 days. Other adverse events were documented.

2OCA was applied to 110 incisions in 99 patients, comprising 62 female and 37 male patients. The mean age of patients was 50.41 (±16.83) years; mean incision length was 10.24 (±5.7) cm, and the mean pain score using a visual analogue scale was 2.37 on a postoperative day 7. The mean drying time was 1.81 (±0.59) minutes; 91 (91%) patients reported excellent and superior satisfaction, and the remaining patients reported “good” (6%) and “fair” (2%) satisfaction. The percentages of dehiscence, hematoma and keloid formation were considerably low.

In this study, 2OCA was safe for musculoskeletal oncology surgical incisions. The incidence of postoperative adverse events was low. However, some patients develop hematomas. Postoperative pain was low, and patient satisfaction was high. 2OCA can be a practical alternative to traditional suture closure for skin incisions after musculoskeletal surgery.
Analysis of the 2012 Canadian Community Health Survey-Mental Health demonstrates employment insecurity to be associated with mental illness
Authors: Kim Il-Ho , Choi Cyu-Chul , Urbanoski Karen , Park Jungwee , Kim Ji Man
Published: December 2021

A growing number of people depend on flexible employment, characterized by outsider employment and lower levels of job security. This study investigated whether there was a synergistic effect of employment status and job insecurity on mental disorders.

This study used data from the 2012 Canadian Community Health Survey-Mental Health (CCHS) of 13,722 Canada's labor force population aged 20 to 70. Data were collected from January to December, 2012, using computer-assisted personal interviewing. As combining employment status with perceived job insecurity, we formed five job categories: secure full-time, full-time insecure, part-time secure, part-time insecure employment, and unemployment.

Results showed that, regardless of employment status (full-time vs part-time), insecure employment was significantly associated with high risk of mental disorders. Furthermore, the odds ratios for insecure employment were similar to those for unemployment. Male workers who are full-time, but with insecure jobs, were more likely to experience mental disorders than female workers.

This study's findings imply that while perceived job insecurity may be a critical factor for developing mental health problems among workers, providing effective health care services can mitigate an excessive health risk for the most vulnerable employment, especially for insecure part-time employment and unemployment.
Dengue 2 serotype and yellow fever coinfection
Authors: Gehrke Flávia , Cardoso Gois Katharyna , da Costa Alves Aguiar Reis Beatriz , Zorello Laporta Gabriel , Affonso Fonseca Fernando Luiz
Published: December 2021

Case Presentation. Arboviruses primarily consist of RNA, which favours greater genetic plasticity, with a higher frequency of mutations that allow the virus to adapt to different hosts. The initial symptomatology is nonspecific, in that the patient can present fever, myalgia, arthralgia, rash and headache. This makes a clinical diagnosis using laboratory tests difficult and time-consuming. In Brazil, the main arboviruses involved in epidemics belong to the family Flaviviridae. The patient in this case is from the municipality of São Bernardo do Campo, an area endemic for arboviruses. He presented symptoms of fever, myalgia and headache.

Results. The multiplex assay for arboviruses detected genetic material from the dengue 2 and yellow fever viruses.

Conclusion. This result confirms the importance of molecular tests showing high sensitivity and specificity that can assist clinical diagnosis, particularly in endemic areas during periods of outbreak for other arboviruses, like the epidemiological picture in Brazil in 2018, when significant co-circulation of dengue virus and yellow fever virus occurred. The presence of co-circulating arboviruses increases the chance of coinfection and demonstrates the importance of differential diagnosis.
Exploiting diverse chemical collections to uncover novel antifungals
Authors: Iyer Kali , Camara Kaddy , Daniel-Ivad Martin , Revie Nicole , Lou Jennifer , Li Sheena , Trilles Richard , Elardo Sheila , Yashiroda Yoko , Fossen Jen , Marchillo Karen , Liu Zhongle , Singh Shakti , Muñoz Jose , Hu Kim Sang , Hirano Hiroyuki , Yoshida Minoru , Osada Hiroyuki , Cuomo Christina , Williams Noelle , Ibrahim Ashraf , Edwards Jack , Andes David , Nodwell Justin , Porco John , Boone Charlie , Mazhab-Jafari Mohammad , Brown Lauren , Whitesell Luke , Robbins Nicole , Cowen Leah
Published: December 2021

The rise in drug resistance amongst pathogenic fungi, paired with the limited arsenal of antifungals available is an imminent threat to our medical system. To address this, we screened two distinct compound libraries to identify novel strategies to expand the antifungal armamentarium. The first collection wasthe RIKEN Natural Product Depository (NPDepo), which was screened for antifungal activity against four major human fungal pathogens: Candida albicans, Candida glabrata, Candida auris, and Cryptococcus neoformans. Through a prioritization pipeline, one compound, NPD6433, emerged as having broad-spectrum antifungal activity and minimal mammalian cytotoxicity. Chemical-genetic and biochemical assays demonstrated that NPD6433 inhibits the essential fungal enzyme fatty acid synthase 1 (Fas1). Treatment with NPD6433 inhibited various virulence traits in C. neoformans and C. auris, and rescued mammalian cell growth in a co-culture model with C. auris. The second compound library screened was adiversity-oriented collectionfrom Boston University. This chemical screen was focused on identifying novel molecules that enhance the activity of the widely deployed antifungal, fluconazole, against C. auris. Through this endeavour, we discovered a potent compound that enhanced fluconazole efficacy against C. auris through increasing azole intracellular accumulation. This activity was dependent on expression of the multidrug transporter geneCDR1, suggesting that this compound targets efflux mechanisms. Furthermore, this molecule significantly reduced fungal burden alone and in combination with fluconazole in a murine model of C. auris disseminated infection. Overall, this work identifies novel compounds with bioactivity against fungal pathogens, revealing important biology, and paving the way for the critical development of therapeutic strategies.
ID-CARD: A clade-specific molecular assay for the detection of 25 Candida spp. causing candidemia based on antifungal susceptibility patterns and in vitro testing of the antifungal activity of a synthetic antimicrobial peptide derived from human lactoferrin (hLF1-11).
Authors: Stavrou Aimilia , Hagen Ferry , Boekhout Teun , Brouwer Carlo
Published: December 2021

Fungal infections are a serious health concern affecting over 1.5 million individuals annually. ID-CARD aims to improve diagnostics taking into account phylogeny and antifungal susceptibility patterns of Candida spp. involved in candidemia.Twenty-five Candida spp. were chosen. Based on ribosomal DNA sequences, clade-specific primers/Taqman probes were designed. Different multiplex panels consisting of four clades that exhibited similar antifungal susceptibility profiles were created. To create the groups, we tested fluconazole and anidulafungin with broth microdilution according to EUCAST against 3-5 isolates/species (n=121), which were also used for specificity testing of the molecular assay. Furthermore, we tested the in vitro activity of hLF(1-11) peptide against isolates that exhibited elevated minimum inhibitory concentrations (MICs) for one or both of the drugs. The groups created are : i. Lodderomyces, Kluyveromyces, Metschnikowiaceae Sensitive, Internal control, (all with low MICs) ii. Pichiaceae, Nakaseomyces, Wickerhamomycetaceae, Debaryomyces & Diutina, (all with high MICs to azoles) and iii. Yarrowia, Wickerhamiella & Meyerozyma, Candida auris, Candida haemulonii complex (all with high MICs to both azoles & echinocandins). The primers/probes showed 100% specificity and capacity for multiplexing. In vitro experiments indicated that hLF(1-11) is fungicidal against various Candidaspp. A synergistic effect of antifungal and hLF(1-11) against various Candida species was shown as combinations of the peptide with antifungals were more effective than these alone ID-CARD will contribute to a fast and reliable molecular detection of yeasts involved in candidiasis. AMPs is a novel way to treat Candida spp. exhibiting high MICs to commonly used antifungal drugs.
Candida albicans cell wall mannosidases, Dfg5 and Dcw1, regulate chitin synthesis
Authors: Maddi Abhiram , Kim Jaewon , Sohi Harleen , Busarajan Sujay , Glagovyak Olga , Knapp Madlin , Chinnici Jennifer
Published: December 2021

In Candida albicans chitin synthesis is important for cell wall integrity and may also have a role in emergence of drug-resistance. Our past studies showed that cell wall mannosidases, Dfg5 and Dcw1, regulate HOG MAPK signaling. In this study, we investigated how Dfg5 and Dcw1 regulate chitin synthesis by affecting HOG, PKC and Calcium-Calcineurin signaling pathways. DFG5 and DCW1 heterologous mutants (ES1 & ES195) and a conditional mutant (ES195+methionine/cysteine) were utilized. WT SC5314 served as negative control and Hog1 knock-out mutant as positive control. Fluorescence microscopy of calcofluor white (CFW) stained mutant and control strains was performed to observe chitin accumulation. Quantitative PCR analysis was performed to measure the relative expression of chitin synthases CHS1, CHS2, CHS3 and CHS8. Incubation with chitinase was done to determine cell separation using light microscopy and scanning electron microscopy (SEM) analysis. Fluorescence microscopy showed significantly increased chitin accumulation in the mutants as compared to wild type. Chitin accumulation was observed mainly at the budding sites indicating a cause for defective cell separation phenotype. Incubation with chitinase led to cell separation in the mutants. CHS2, CHS3 and CHS8 expression was observed to be significantly upregulated in the conditional mutant and HOG1 mutant as compared to the wild type. This upregulation was also observed when the cell wall integrity PKC pathway was activated. However, activation of the Calcium-calcineurin pathway downregulated chitin synthase expression in the mutants. Our data indicates that Dfg5 and Dcw1 regulate expression of chitin synthases via HOG MAPK, PKC and Calcium-calcineurin signaling pathways.
Discovering the chlamydospore regulatory network in Candida albicans
Authors: Bapat Priyanka , Nobile Clarissa
Published: December 2021

A normal resident of healthy humans and warm-blooded animals, C. albicans is a commensal fungus that is also among the most common opportunistic pathogens of humans. C. albicans forms unique morphological structures called chlamydospores, which are large, spherical, thick-walled structures formed at the ends of hyphae that have unknown biological function. My goal is to discover the regulatory network controlling chlamydospore formation in C. albicans. By determining this network, we can gain insight into the biological roles of chlamydospores in the C. albicans lifestyle, better understand C. albicans morphological transitions, and determine the selective advantage (if any) provided by chlamydospores to this pathogenic fungus. To determine this regulatory network, I have screened a library of 211 C. albicans transcription factor (TF) homozygous deletion mutants to assay for their abilities to form chlamydospores under standard chlamydospore-inducing growth conditions. I have identified seven TF mutants that fail to produce any chlamydospores andthree TF mutants that produce high levels of chlamydospores relative to WT. To characterize the transcriptional changes occurring during chlamydospore formation, I have performed RNA sequencing (RNA-seq) on these identified regulator mutants to uncover the differentially regulated target genes of each chlamydospore regulator. I will use genome-wide chromatin immunoprecipitation followed by sequencing (ChIP-seq) on epitope-tagged versions of these regulators to determine which genes are directly under the control of each TF. RNA-seq coupled with ChIP-seq will allow me to determine the regulatory network controlling chlamydospore formation in C. albicans.
Drug tolerance facilitates the evolution of drug resistance in Candida albicans
Authors: Massahi Samira , Bettauer Van , Khurdia Sanny , Khosravi Nasim , Simpson Shawn , Harb Mathieu , Dumeaux Vanessa , Whiteway Malcolm , Hallett Michael
Published: December 2021

Background

For Candida albicans and Candidiasis, drug resistance is sometimes due to the pre-existence of genetic polymorphisms that bypass the mode of action of the drug, thus conferring a long-term survival benefit. In other cases, resistance is acquired via the evolution of de novo genetic polymorphisms. There is evidence that C. albicans possess a drug tolerance response which “buys time” for individuals to evolve beneficial mutations. Our goal here is to characterize this poorly understood epigenetic cytoprotective program at the single cell molecular level.

Methods

We developed a nano-litre droplet based Candida single cell sequencing platform capable of transcriptionally profiling several thousand individual cells in an efficient manner. We exploit this platform to profile both untreated and drug exposed (incl. fluconazole, caspofungin and nystatin) populations at early time points post-treatment (tolerance) and late time points (resistance) in order to understand survival trajectories. The profile are compared with the matched sequenced genomes.

Results

We show that untreated Candida populations exhibit “bet hedging”, stochastically expressing cytoprotective transcriptional programs, and drug tolerant individuals partition into distinct subpopulations, each with a unique survival strategy involving different transcriptional programs. We observe a burst of chromosomal aberrations at two days post-treatment that differ between survivor subpopulation.

Discussion

Our single cell approach highlights that survivor subpopulations pass through a tolerance phase that involves a multivariate transcriptional response including upregulation of efflux pumps, chaperones and transport mechanisms, and cell wall maintenance. Together this suggests that targeting the tolerance response concomitantly with standard therapies could represent an efficient approach to ablating clinical persistence.