Medicine

Mi, Junjie; Wang, Rong; Han, Xiaofang; Ma, Ruijun; Li, Huiying

doi: 10.1097/md.0000000000036228pmid: 38050202

Background: Selecting the appropriate patient for further treatment after surgery for gastric cancer can improve the patient prognosis. Circulating tumor DNA (ctDNA) has the potential to predict recurrence and prognosis after gastric cancer surgery, but the results are still inconclusive. As the completed studies had small sample sizes and were inconsistent, a meta-analysis was conducted to assess the effect of ctDNA on recurrence and prognosis after gastric cancer surgery. Methods: PubMed, Embase, Scopus, and the Web of Science were searched for potentially eligible studies published up to April 7, 2023. Pooled relative risk (RR) and pooled hazard ratio (HR) were calculated to evaluate recurrence, recurrence-free survival (RFS), and overall survival (OS) following gastric cancer surgery. Results: A pooled analysis revealed that patients who were ctDNA positive before and after surgery were at a high risk of gastric cancer recurrence (RR = 1.79, 95% CI: 1.19–2.71; RR = 3.17, 95% CI: 2.36–4.25). The pooled data revealed that ctDNA-positive patients had a poorer RFS and OS (HR = 6.37, 95% CI: 2.70–15.01; HR = 4.58, 95% CI: 1.68–12.49). Conclusions: ctDNA-positive patients were at a high risk of recurrence after gastric cancer surgery and had a poorer prognosis. Hence, ctDNA-positive patients needed close follow-up and further treatment.

Maeda-Minami, Ayako; Kawamoto, Ayako; Yoshino, Tetsuhiro; Yokoyama, Yuta; Suzuki, Sayo; Horiba, Yuko; Nakamura, Tomonori; Mimura, Masaru; Watanabe, Kenji

doi: 10.1097/md.0000000000036191pmid: 38050203

Two representative Kampo formulas, keishibukuryogan and tokishakuyakusan, are frequently prescribed for patients with dysmenorrhea. We previously constructed a model that could predict which of these 2 formulas was most suitable, which is based on 4 subjective symptoms and 3 objective signs. To evaluate the prognosis of patients with dysmenorrhea using the established prediction model and assess the treatment outcomes between those treated in accordance with the prediction model and those who received various other treatments. In this retrospective, observational study, we included patients with menstrual pain who visited the Kampo Clinic at the Keio University Hospital for the first time between October 2014 and December 2020. These patients were monitored over a 90-day follow-up period. Participants were categorized into 2 groups: model-accordance and various-options. The progression of visual analogue scale (VAS) values was evaluated by determining the slopes from regression analysis between these 2 groups, with changes corroborated by the medical records. The study comprised 57 patients: 37 in the model-accordance group and 20 in the various-options group. Notably, the various-options group reported a significantly higher number of subjective symptoms (P = .03). The VAS value showed a decline, as indicated by the negative slope value of the regression line, across both groups – irrespective of their classification. There were no significant differences in the occurrence of adverse events between the 2 groups. The prognosis of patients with dysmenorrhea and the incidence of adverse events remained consistent, regardless of whether the treatment approach was in accordance with the prediction model or varied. Further studies are warranted to assess the prognosis when Kampo formulas are chosen based on the prediction model in the various-options population.

Cai, Xiaqin; Fu, Yizhou; Hong, Ke; Zhou, Yuefang; Qi, Guangju

doi: 10.1097/md.0000000000036383pmid: 38050207

Background: Corneal pregnancy is rare and difficult to detect in the early stages. Due to the abundant blood supply in this area, a rupture can result in massive internal bleeding, shock, and even death. Therefore, immediate surgery is necessary, and patients must replenish their blood volume as soon as possible to ensure blood supply to important organs. For those whose blood pressure cannot immediately rise, surgery should be performed while resisting shock to buy time. Case summary: We present the case of a 34-year-old Chinese woman at 19 weeks of gestation who had a corneal pregnancy. No abnormalities were detected in the examinations in the first trimester. This patient was 19 weeks pregnant and sought medical advice due to sudden lower abdominal pain, syncope, and hemorrhagic shock. After rescue and treatment, she recovered and was discharged from the hospital, afterwards, the patient gave birth to a child 7 years later. Conclusion: The early diagnosis of cornual pregnancy is mainly based on ultrasound. However, there is a high incidence of missed diagnosis and misdiagnosis of this disease. Patients may face serious and life-threatening conditions in case of the rupture of cornual pregnancy. This disease can be mainly treated by surgery.

Naito, Yohei; Hasegawa, Masahiro; Tone, Shine; Wakabayashi, Hiroki; Sudo, Akihiro

doi: 10.1097/md.0000000000036257pmid: 38050300

The purpose of this study was to evaluate the mid-term clinical results and polyethylene wear of vitamin E-diffused highly cross-linked polyethylene (HXLPE) and 2-methacryloyloxyethyl phosphorylcholine (MPC)-grafted HXLPE in cementless total hip arthroplasty (THA). Thirty-four THAs with vitamin E-diffused HXLPE (VEPE) and 32-mm cobalt-chromium head, and 116 THAs with MPC-grafted HXLPE and 32-mm alumina head were evaluated. The Merle d’Aubigné and Postel scores were administered. Kaplan–Meier survivorship was analyzed. Annual radiographs were analyzed using computerized method and linear steady-state wear rate was measured. The mean duration of follow-up was 9 years (range, 7–11 years) in VEPE group and 8 years (range, 7–10 years) in MPC group. The mean Merle d’Aubigné and Postel scores improved postoperatively in both groups. Kaplan–Meier survivorship with endpoint of revision was 100% (95% confidence interval, 100%–100%) in VEPE group and 98.3% (95% confidence interval, 93.4%–99.6%) in MPC group at 10 years (P = .44). The mean steady-state wear rate was 0.007 mm/year in VEPE group and 0.006 mm/year in MPC group (P = .60). The clinical results of both groups were good and wear rates of both liners were very low.

Li, Hao; Zhang, Tao

doi: 10.1097/md.0000000000036060pmid: 38050215

Rationale: Injection-related abscesses are a common complication in clinical practice, but the identification of infected bacteria might be difficult. Patient concerns: A 51-year-old female patient was admitted to the hospital due to a lump on her right buttock that emerged after receiving intramuscular injections to treat left shoulder joint pain. The lump gradually enlarged into a 3.0 to 4.5 cm mass at the time of admission with symptoms such as skin redness, itching, and pain. Diagnoses: The patient received ultrasonic and other laboratory examinations. Laboratory results from the drainage indicated that the infection was caused by a rapidly growing mycobacteria and was confirmed as Mycobacterium fortuitum by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Interventions: The patient was treated with antibiotics for 12 days after incision and drainage of the abscess in the right buttock. Local dressings were changed regularly. A migration lesion that appeared 3 days after treatment was drained and cleaned when it matured. Outcomes: The lesion substantially decreased in size and the patient was discharged after 2 months of treatment. Lessons: Rapidly growing mycobacteria are rare but important pathogens that should be considered in patients with injection-related abscesses. Early identification and appropriate treatment can result in a favorable prognosis.

Quan, Qiuying; Guo, Lingchuan; Huang, Lili; Liu, Zhiju; Guo, Tianwei; Shen, Yu; Ding, Sisi; Liu, Cuiping; Cao, Lei

doi: 10.1097/md.0000000000036323pmid: 38050283

Programmed death-ligand 1 (PD-L1) is a crucial negative costimulatory molecule expressed on both tumor and immune cells. It binds to programmed death-1, facilitating tumor escape. Tumor-infiltrating immune cells play a vital role in this process. However, the clinical relationship between PD-L1 expression and tumor-infiltrating immune cells remains uncertain. Immunohistochemistry (IHC) was utilized to assess PD-L1 expression and TIIC markers (CD3, CD4, CD8, CD19, CD31, CD68, CD11c, CD56, and α-smooth muscle actin) in gastric adenocarcinoma tissues from 268 patients. The aim was to explore the prognostic significance of PD-L1 and the infiltration of different immune cell types. The study analyzed overall survival and the correlations between PD-L1 expression, immune cell infiltration, and clinicopathological characteristics. Among the 268 patients, 52 (19.40%) exhibited high PD-L1 expression on tumor cells (TPD-L1), while 167 (62.31%) displayed high PD-L1 expression on immune cells (IPD-L1). Patients with high IPD-L1 expression showed improved survival compared to those with low IPD-L1 expression (P = .028). High TPD-L1 expression associated with various clinicopathological features, such as larger tumor size, poorer differentiation, deeper invasion depth, and higher tumor stage. Conversely, patients with high IPD-L1 expression exhibited shallower tumor invasion and lower mortality rates. Univariate analysis indicated that superficial tumor infiltration, absence of lymph node and distant metastasis, low tumor stage, high IPD-L1 expression, and elevated CD8 and CD19 expression were associated with a reduced risk of tumor progression. Multivariate analysis revealed that patients with high IPD-L1 and CD8 expression or high TPD-L1 and low CD31 expression experienced significantly better overall survival than patients with other combinations. The findings indicate that patients with high PD-L1 expression in immune cells have a substantially improved prognosis. Additionally, the combination of PD-L1 with CD8 or CD31 expression status can serve as an indicator of prognosis in patients with gastric adenocarcinoma.

Chen, Guansheng; Guo, Jiayi; Li, Wenjing; Zheng, Rong; Shang, Hongyu; Wang, Yongjun

doi: 10.1097/md.0000000000036339pmid: 38050316

Circulating microRNAs (miRNAs) can serve as noninvasive biomarkers for endometriosis, but their diagnostic and prognostic values require investigation. This study evaluated the potential of 6 miRNAs in diagnosing endometriosis and predicting fertility. The study included patients with endometriosis (stages I–IV) and controls admitted to Sun Yat-Sen Memorial Hospital between May 2013 and March 2014. The serum expression levels of 6 miRNAs (miR-199a, miR-145*, miR-122, miR-9*, miR-141*, and miR-542-3p) were determined using qRT-PCR. Receiver operating characteristics curves were used to determine the diagnostic accuracy. The study included 155 patients with endometriosis and 77 controls. The model combining miR-199a, miR-122, miR-145*, and miR-141* with the carbohydrate antigen 125 (CA125) exhibited 81.8% sensitivity and 92.6% specificity and an area under the curve of 0.939 for diagnosing endometriosis. When combining miR-199a, miR-122, miR-145*, miR-542-3p, and CA125, the receiver operating characteristics curve showed an area under the curve of 0.759 and 79.6% sensitivity and 73.5% specificity for stage I/II versus III/IV endometriosis. Circulating miRNA levels were associated with pelvic adhesions (miR-199a, P < .05), lesion distribution (miR-9*, miR-145*, and miR-141*; all P < .05), and the presence of deep infiltrating endometriosis (miR-199a and miR-122; both P < .001). The expression levels of miR-199a, miR-122, and miR-542-3p decreased with an increasing endometriosis fertility index. The model combining circulating miRNAs (miR-199a, miR-122, miR-145*, and miR-141*) and CA125 is promising for diagnosing endometriosis and its severity. miR-199a, miR-122, and miR-542-3p were associated with the endometriosis fertility index and might be used to predict fertility preoperatively, but these results require confirmation.

Zhu, Yonglin; Ma, Guannan; Ren, Wei; Hu, Zhenyu; Zhou, Ling; Zhang, Xin; Zhao, Na; Zhang, Mingding; Yan, Lei; Yu, Qian; Liu, Xuetong; Chen, Jichao

doi: 10.1097/md.0000000000036320pmid: 38050216

Complex microbial ecosystems in both gastrointestinal and respiratory systems have been found to have a significant impact on human health. Growing evidence has demonstrated that intestinal dysbiosis can increase vulnerability to pulmonary infections. However, changes in the composition and activity of the intestinal flora after probiotic supplementation may alter the disease state of the host. The effects of probiotics on the improvement of diseases, such as severe pneumonia (SP), in intensive care units (ICUs) remain controversial. We retrospectively included 88 patients diagnosed with severe pneumonia between April 2021 and June 2022. The patients were divided into 2 groups: a probiotic group (n = 40) and a control group (n = 48). In addition, changes in CRP, PCT, WBC, IL-6, Clostridium difficile toxin, and PSI pneumonia scores were assessed. Changes in the gut microbiome of the patients were assessed using amplicon sequencing. Compared to the control group, a significant reduction in the incidence of length of hospital stay was observed in the probiotic group, but there were no significant differences in the mortality rate, duration of fever, diarrhea, and constipation. After probiotic treatment, CRP, PCT, WBC, and PSI score were significantly lower than before, and better clinical efficacy was achieved in the probiotic group for the duration of antibiotic therapy. Gut microbiota analysis revealed that the abundance of opportunistic pathogens (e.g., Massilia) increased remarkably at the genus level in the control group, and a significant increase in Erysipelotrichaceae_ge was observed after probiotic intervention. The control group showed an increase in opportunistic pathogens (Citrobacter, Massilia) during the antibiotic treatment. Probiotics interventions inhibit the growth of opportunistic pathogens. In addition, we found that the population of butyrate-producing bacteria (e.g., Ruminococcaceae UCG-005) increased following probiotic treatment.

Alhammad, Saad A.; Almutairi, Faisal M.; Bajsair, Abdulaziz S.; Alghamdi, Abdulrahman S.; Algarni, Fahad S.; Aldaihan, Mishal M.; Alshehri, Waleed M.; Alwadeai, Khalid S.

doi: 10.1097/md.0000000000036386pmid: 38050194

Physical inactivity and sedentary behavior pose significant health concerns, particularly among young adults like college students. However, little research exists on the attitudes towards physical activity among Saudi Arabian healthcare students. This study aimed to assess the prevalence of physical activity and determine the reason for being physically inactive among students and interns across all programs in the College of Applied Medical Sciences (CAMS) at King Saud University (KSU), Riyadh, Saudi Arabia. A cross-sectional online survey was conducted between March and May 2023. CAMS students aged 18 and above, fluent in Arabic or English, and willing to participate were included. The Global Physical Activity Questionnaire (GPAQ) was used to measure physical activity. Descriptive statistics were used for data analysis. Out of 433 respondents, 377 met the inclusion criteria (response rate: 89.3%). Physical activity prevalence was 54.60%, with walking being the most common activity (42.70%). Lack of time was the primary reason for inactivity (51.40%). On average, students engaged in 1.5 hours/day of vigorous-intensity activities and 1.3 hours/day of vigorous-intensity sports and fitness activities at work. Sedentary behavior, characterized by continuous sitting, averaged 5.37 hours per day. Approximately half of CAMS students are physically active, while 20% rely solely on short walks due to time constraints, limited activity hours, or sedentary habits. A lack of time was cited as the primary reason for inactivity by most students. Future research should focus on strategies to enhance physical activity among healthcare students. In addition, academicians and policymakers should propose time-efficient initiatives that accommodate the demanding and busy schedules of healthcare students.

Li, Yuehong; Liu, Ting; Lai, Xiaoyan; Xie, Huifang; Tang, Heng; Wu, Shuangchan; Li, Yongshun

doi: 10.1097/md.0000000000036188pmid: 38050301

Cyclophilin D (CypD) is a mitochondrial matrix peptidyl prolidase that regulates the mitochondrial permeability transition pore. Inhibition of CypD was suggested as a therapeutic strategy for acute pancreatitis. Peptide inhibitors emerged as novel binding ligand for blocking receptor activity. In this study, we present our computational approach for designing peptide inhibitors of CypD. The 3-D structure of random peptides were built, and docked into the active center of CypD using Rosetta script integrated FlexPepDock module. The peptide displayed the lowest binding energy against CypD was further selected for virtual iterative mutation based on virtual mutagenesis and molecular docking. Finally, the top 5 peptides with the lowest binding energy was selected for validating their affinity against CypD using inhibitory assay. We showed 4 out of the selected 5 peptides were capable for blocking the activity of CypD, while WACLQ display the strongest affinity against CypD, which reached 0.28 mM. The binding mechanism between WACLQ and CypD was characterized using molecular dynamics simulation. Here, we proved our approach can be a robust method for screening peptide inhibitors.