Medicine

Wang, Kai; Zhuang, Ling-Ling; Shen, Hai-Lan; Su, Rui-De; Luo, Zhen-Yu; Wang, Wen-Rong

doi: 10.1097/md.0000000000033532pmid: 37026901

To analyze the efficacy and influencing factors of Mifepristone combined with estrogen-progesterone sequential therapy (Femoston) in the treatment of incomplete abortion. This retrospective cohort study included 93 patients with incomplete abortion. All patients took 50 mg of Mifepristone 2 times a day for 5 days and then took Femoston once a day (starting with estradiol tablets/2 mg) for 28 days. Without any indication of intrauterine residue by ultrasonic examination was judged to be effective. According to statistical analysis, this study calculated the effective rate and analyzed its influencing factors. A 2-sided value of P < .05 was considered statistically significant. The total response rate of the treatment regimen was 86.67%. body mass index was a significant influencing factor for treatment outcome (OR 0.818, 95% confidence interval 0.668–0.991, P = .041). For patients with incomplete abortion, Mifepristone combined with estrogen-progesterone sequential therapy has a remarkable therapeutic effect. Patients with a lower body mass index may respond much more significantly to this treatment regimen.

Xia, Yuansheng; Chen, Huiyan

doi: 10.1097/md.0000000000033511pmid: 37026909

Background: This study aimed to assess the association between the T950C polymorphism and osteoporosis in postmenopausal Chinese women to further reduce the influence of different genetic backgrounds by meta-analysis and subgroup analysis. Methods: Through November 2022, a systematic online investigation was performed with the aid of the Cochrane Library, EMBASE, PubMed, Web of Science and the Chinese National Knowledge Infrastructure to find case-control studies looking into the correlation between the osteoprotegerin gene (OPG) T950C polymorphism and postmenopausal osteoporosis susceptibility. Results: This study included 6 studies with a total of 1669 postmenopausal osteoporosis cases and 2992 controls. In the recessive model, postmenopausal women with the CC genotype (mutant homozygote at the T950C locus) had a lower risk of osteoporosis, indicating that the CC genotype of OPG T950C might show a preventive effect on osteoporosis after menopause. In a stratified analysis by geographic area, the population from South China had a significantly higher risk under the dominant model [CC + TC (heterozygote at the T950C locus) vs TT (wild-type homozygotes at the T950C locus): odds ratio = 1.34, 95% confidence interval = 1.17–1.54, P < .01], while the population from South China had a significantly lower risk under the recessive model (CC vs TC + TT: odds ratio = 0.79, 95% confidence interval = 0.69–0.95, P = .02). Conclusions: Together, the OPG T950C polymorphism may be associated with osteoporosis risk in postmenopausal Chinese women, according to this meta-analysis. Because of the study’s limitations, more large-scale research is needed to corroborate these findings.

Ewid, Mohammed; Amal, Yassien; Billah, Syed Muhammad Baqui; Kalou, Yazan; Zitoun, Osama A.; Alnaser, Adnan Raed; Nashawi, Mhd Oubai; Almazrou, Abdulrahman

doi: 10.1097/md.0000000000033487pmid: 37026919

The COVID-19 pandemic is a major health care catastrophe that affects people’s physical and mental well-being worldwide. Medical students are at an increased risk of mental health hazards during the COVID-19 pandemic. Sulaiman Al Rajhi University (SRU), the site of our study, is located in Qassim province in the Kingdom of Saudi Arabia. We conducted this study to assess the prevalence of depression, stress and anxiety symptoms among SRU medical students during the quarantine and while learning online shortly after the announcement of documented COVID-19 cases in Kingdom of Saudi Arabia. In this cross-sectional study, an online questionnaire was sent to all medical students of SRU; 278 students responded (71%). We collected participants’ demographic, socioeconomic, and academic data. The Depression, Anxiety, and Stress scale and the Fear of COVID-19 Scale were used as the validated mental health assessment tools. Depression, anxiety and stress symptoms were found in 23%, 11%, and 6% of students, respectively. Females were more likely to have anxiety (P = .03) than males. Students who had close contact with COVID-19 cases, those whose lives were affected by COVID-19, and those with poor socioeconomic status had significantly higher levels of stress, anxiety, and depression compared to their counterparts (P = .004, .01, .01, respectively). Students from high-viral-load areas, unmarried students, and those who did not live with their families were more stressed (P = .06, .01, .01, respectively). The Fear of COVID-19 Scale was positively correlated with all Depression, Anxiety, and Stress components (depression: r = 0.36, anxiety: r = 0.45, and stress: r = 0.39, P < .001 for all). Medical students, especially female students, are at an increased risk of developing depression, anxiety, and stress symptoms with increased COVID-19 fear during the pandemic. The study highlights the importance of mental health screening for female students, students of low socioeconomic status, and relatives of COVID-19 cases. Our findings could help institutions adjust mental health services in the future amid such pandemics.

Zheng, Wenli; Fan, Shiqin; Chen, Jie; Ma, Jing

doi: 10.1097/md.0000000000033436pmid: 37026946

Rationale: Hyponatremia is a common electrolyte disorder in elderly critically ill patients, and it may be associated with poor outcomes, higher morbidity, and mortality. Syndrome of inappropriate antidiuresis (SIAD) is one of the main causes of hyponatremia, with an insidious onset that is highly misdiagnosed. Primary empty sella lesions are specific, mostly asymptomatic, and easily overlooked. SIAD combined with empty sella is much rarer in clinic, this article focuses on the diagnosis and management of an elderly patient with intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella. Patient concerns: An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia. Diagnoses: The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function. Interventions: Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance. Outcomes: His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500–2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy. Lessons: Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.

Zheng, Sihan; Qin, Fengfeng; Yin, Ji; Li, Daiying; Huang, Yanlin; Hu, Lanxin; He, Lu; Lv, Caifeng; Li, Xiaohui; Li, Sen; Hu, Wenjian

doi: 10.1097/md.0000000000033158pmid: 37026902

The actin 2/3 complex (Arp2/3) regulates actin polymerization and nucleation of actin filaments, is associated with cell motility, and has been shown to play a key role in the invasion and migration of cancer cells. nucleation-promoting factor (NPF) such as N-WASP (neural-WASP famly verprolin-homologous protein family), WAVE (WASP famly verprolin-homologous protein family), and WASH (WASP and Scar homologue) undergo conformational changes upon receipt of multiple upstream signals including Rho family GTPases, cdc42 (Cell division control protein 42 homolog), and phosphatidylinositol 4,5-bisphosphate (PtdIns 4,5 P2) to bind and activate the Arp2/3 complex. Once activated, the Arp2/3 complex forms actin-based membrane protrusions necessary for cancer cells to acquire an invasive phenotype. Therefore, how to influence the invasion and migration of cancer cells by regulating the activity of the Arp2/3 complex has attracted great research interest in recent years. Several studies have explored the effects of phosphorylation modifications of cortactin and several NPFs (Nucleation Promoting Factor) including N-WASP and WAVE on the activity of the Arp2/3 complex and ultimately on cancer cell invasiveness, and have attempted to suggest new strategies for antiinvasive therapy as a result. Other studies have highlighted the potential of targeting genes encoding partial or complete proteins of the Arp2/3 complex as a therapeutic strategy to prevent cancer cell invasion and metastasis. This article reviews the role of the Arp2/3 complex in the development, invasion, and metastasis of different types of cancer and the mechanisms regulating the activity of the Arp2/3 complex.

Seo, Jeong Pyo; Koo, Dong Kyun

doi: 10.1097/md.0000000000033370pmid: 37026940

The nigrostriatal tract (NST) is a dopaminergic pathway that runs from the substantia nigra pars compacta in the midbrain to the dorsal striatum (caudate nucleus and putamen) and regulates voluntary movement via the basal ganglia motor loops. However, it is unclear whether the effects of ischemic stroke, such as middle cerebral artery (MCA) infarction, are associated with changes in the NST. Thirty MCA infarct patients and 40 healthy subjects with no history of psychiatric or neurological disorders were enrolled in the present study. Diffusion tensor tractography was used to investigate injury to the ipsilesional and contralesional NST in MCA infarct patients compared to the normal human brain. There was a significant difference in the mean fractional anisotropy and tract volume values of the NST between the patient and control groups (P < .05). post hoc analysis revealed that the mean fractional anisotropy and tract volume from the ipsilesional NST showed a significant difference compared with those of the contralesional NST and control groups (P < .05). MCA infarction can lead to damage to the ipsilesional NST, which can impair one’s ability to stop unwanted muscular contractions or voluntary movement.

Liu, Yangjun; Xie, Wei; Li, Juan; Ossowski, Zbigniew

doi: 10.1097/md.0000000000033147pmid: 37026928

Background: nonalcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of fat in the liver without alcoholism. We conducted a systematic review and meta-analysis to elucidate the efficacy of aerobic exercise on metabolic indicators and physical performance of adult patients with NAFLD. Methods: To conduct the systematic review and network meta-analysis, 2 researchers searched PubMed, EBSCO, and Web of science databases to identify randomized clinical trials of aerobic exercise interventions for adults with NAFLD published between inception and July 2022. We assessed the methodological quality of the included literature using the Cochrane Risk Assessment Scale and the PEDro Scale. Relevant data were extracted, variables were converted to the same units, and meta-analysis was performed using RevMan 5.4 software. We compared mean differences (MD) between experimental and control groups. For each outcome analyzed, we expressed data as MD with 95% CI to compare metabolic markers and exercise capacity between the experimental and control NAFLD patients. Results: Eleven randomized clinical trials with a total of 491 individuals with NAFLD were included in accordance with the criteria of this study. Types of aerobic exercise include moderate or high-intensity interval running, cycling, Nordic walking, equipment training, etc; Training duration 4 to 16 weeks, 30 to 60 minutes 3 or more times a week. Compared with the control group, aerobic exercise group had reduced weight of patients, (MD) 1.20 kg (95% CI: −1.38 to −1.01 kg, P < .00001). Seven studies confirmed that aerobic exercise significantly reduced triglycerides, (MD) 3.00 mg/dL (95% CI: −5.80 to −0.21 mg/dL, P = .04); increased high density lipoproteins (MD) 5.96 mg/dL (95% CI: 2.95 to 8.96 mg/dL, P = .0001) and reduced low-density lipoproteins (MD) 6.45 mg/dL (95% CI: −8.53 to −4.37 mg/dL, P < .00001); the study also showed that aerobic exercise reduced the liver enzymes aspartate aminotransferase and alanine aminotransferase to varying degrees. Aerobic exercise can improve physical performance and increase peak oxygen consumption of (MD) 6.29 mL/Kg*minutes, (95% CI: 3.05–9.53mL/Kg*minutes, P = .0001). Conclusion: Aerobic exercise significantly reduced weight and improved metabolic index and physical performance. Impacted by the limitations of various regimens, doses, duration, center settings, populations enrolled, the study had certain limitations. The randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of physical performance and metabolic capacity in this population.

Mino, Rina; Shimada, Hiromi; Wakiya, Risa; Nakashima, Shusaku; Miyagi, Taichi; Sugihara, Koichi; Ushio, Yusuke; Mizusaki, Mao; Chujo, Kanako; Kameda, Tomohiro; Kanenishi, Kenji; Kadowaki, Norimitsu; Dobashi, Hiroaki

doi: 10.1097/md.0000000000033462pmid: 37026900

We aimed to determine the association between disease activity during pregnancy and pregnancy outcomes of women with polymyositis and dermatomyositis (PM/DM). Patients with PM/DM who were managed from pregnancy to delivery at Kagawa University Hospital from March 2006 to May 2021 were enrolled. Clinical data were retrospectively analyzed to evaluate the association between disease activity during pregnancy and pregnancy outcomes. Eight pregnancies in 5 women with PM/DM were analyzed. The mean age at conception was 28.3 ± 3.8 years, and mean disease duration was 6.3 ± 3.2 years. Four patients required an increased glucocorticoid dosage because of worsening disease activity (sustained elevation of creatine phosphokinase [CPK] concentration). Two patients who continuously received immunosuppressive drugs from conception to delivery showed no increase in disease activity and did not need increased glucocorticoid dosages. The pregnancy outcomes were 1 spontaneous abortion and 7 live births. The mean gestation length was 35.3 ± 5.2 weeks, and mean birthweight was 2297.7 ± 1041.4 g. Five adverse pregnancy outcomes (APOs) occurred (2 preterm births and 4 low birthweights); most of these cases had sustained elevation of CPK concentration and increased glucocorticoid dosages. No APOs occurred in the 2 patients who received continuous immunosuppressive medication. Continued use of pregnancy-compatible medications and control of disease activity with lower glucocorticoid dosages in pregnancies with PM/DM may be important to achieve good pregnancy outcomes.

Yang, Jian-Bing; Wang, Long-Fei; Cao, Yun-Fei

doi: 10.1097/md.0000000000033473pmid: 37026944

Postoperative delirium is a common postoperative complication of neurocognitive dysfunction, especially in elderly surgical patients. Postoperative delirium not only damages patients’ recovery but also increases social costs. Therefore, its prevention and treatment has essential clinical and social significance. However, due to its intricate pathogenesis and limited pharmacological interventions, the effective prevention and treatment of postoperative delirium remains a thorny problem. As traditional acupuncture therapy has been shown to be an effective treatment in many neurological disorders, and in recent years, it has begun to be clinically used as an intervention for postoperative delirium. Although most clinical and animal studies confirm that multiple types of acupuncture interventions can alleviate or prevent postoperative delirium by relieving acute postoperative pain, reducing the consumption of anesthetics and analgesics, attenuating neuroinflammation and neuronal lesions, while more evidence-based medical evidence and clinical validation are needed for these encouraging effects.

Yu, Li; Li, Yun; Wang, Xiao-Fei; Zhang, Zhao-Qing

doi: 10.1097/md.0000000000033125pmid: 37026956

To explore the value of artificial intelligence combined with musculoskeletal ultrasound in the differential diagnosis of pain rehabilitation of scapulohumeral periarthritis. A total of 165 patients with periarthritis of the shoulder, who were admitted to our hospital from January 2020 to January 2022, were selected. Konica SONIMAGE HS1 PLUS color Doppler ultrasound diagnostic instrument was used to detect muscles and bones of patients with scapulohumeral periarthritis. This study proposed an intelligent clustering analysis algorithm with musculoskeletal ultrasound parameters. The neural network was trained on a GeForce RTX 3060 with the Adam W optimizer, a batch size of 12, and an initial learning rate of 5E-4. Each batch of 2 types of trained samples was input into the network in a specific proportion. Pain was assessed on a 10-point visual analogue scale. On the affected side of scapulohumeral periarthritis, the mild pain group showed thickening of the shoulder posterior capsule (2.02 ± 0.72) mm with clear edges. In the moderate pain group, the thickness of the shoulder posterior capsule gradually narrowed (1.01 ± 0.38) mm and became even thinner than that of the unaffected side, with irregular and blurred edges. In the severe pain group, the thickness of the shoulder posterior capsule largely returned to normal (1.21 ± 0.42) mm, and the edge was clear. Multivariate logistic regression showed that in addition to musculoskeletal ultrasound parameters, the length of service, work nature, and the busy degree of work of patients with periarthritis of the shoulder were significant factors that influenced shoulder periarthritis pain (P < .05). The performance of the proposed intelligent auscultation algorithm was further examined in a clinical setting, in which we used 165 clinical musculoskeletal ultrasound samples (including 81 positive and 84 negative samples) as a test set. The accuracy, sensitivity, and specificity were 0.833, 0.872, and 0.801, respectively. Musculoskeletal ultrasound combined with artificial intelligence algorithm is a new diagnostic and staging tool for scapulohumeral periarthritis.