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The basilar artery has the most perioperative complications in stenting compared to the other intracranial arteries. We aim to study whether the procedural safety in stenting for basilar stenosis has improved. This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. Between January 2012 and March 2019, 147 consecutive patients with symptomatic basilar stenoses receiving elective stenting treatment were included in current basilar artery stenting (BAS) group. The prospectively collected and registered 120 patients by the same interventional team from September 2001 to November 2011 were set as historical BAS group for control. A total of 267 individuals were included in this study, with a mean age of 59.5 ± 8.1 years. The proportion of patients with lesion length15 mm was 26.5% (39/147) in the current BAS group versus 4.2% (5/120) in the historical BAS group. We found significant differences between these 2 groups in Mori A (17.7% vs 42.5%) and Mori C patients (42.9% vs 13.3%). The proportion of patients receiving preoperative high-resolution magnetic resonance (HRMRI) evaluation was 83.0% (122/147) in the current BAS group versus 20.8% (25/120) in the historical group (P .05). Balloon-expendable stent (BES) (n = 1), Wingspan (n = 34), and Enterprise (n = 112) stents were placed in the current BAS group. In contrast, only balloon-expendable stent (BES) (n = 48) and Wingspan (n = 72) were deployed in the historical BAS group. The incidence of the safety endpoint (SE) was 4.1% (involving 6 patients) in the current BAS group versus 11.7% (involving 14 patients) in the historical BAS group (P .05). In multivariate analysis, no risk factor was associated with the occurrence of the safety endpoint (SE). When BAS cases operated by the surgical team accumulated to 120 to 150, the incidence of complications decreased significantly. This is the largest sample size study to discuss the safety of BAS. The significantly decreased incidence of complications indicates that the improving technical measures and the accumulation of operation experience are necessary.

The study describes epidemiological features and transmission of other infectious diarrhea (OID) before and during the epidemic of COVID-19 in China, which lays a foundation for OID prevention and control. Incidence rate and mortality data of OID containing detailed epidemiological information such as date, age and region from 2004 to 2017, and total OID case number from 2018 to 2020 were obtained from the Data Center of China's Public Health Science and the National Bureau of Statistics' statistical yearbook. The Joinpoint regression model and Z test was used to analyze, while R language and ArcGIS 10.5 for drawing. The autoregressive integrated moving average model was used to predict the influence of COVID-19 on OID. The OID incidence rate increased from 31.69/10 million in 2004 to 92.42/10 million in 2017, and the mortality rate decreased from 1.82/10,000 to 0.14/10,000. The male to female incidence ratio was 1.39:1 (P .001). The patients' age showed a decreased trend with age (P .001). The scattered children devoted the most OID incidence rate. The bimodal distribution of OID incidence was summer peak in northern China, 2 apparent peaks in central and eastern, and winter peak in southern. The autoregressive integrated moving average model predicted 1,406,557 in 2020, comparing the actual OID cases in 2020 to 1,062,277. Affected by the epidemic control measures of COVID-19, the number of OID cases declined by 32.4% (Absolute percentage error = 32.4%). The OID incidence rate in China continuously increased and showed a bimodal distribution in summer and winter with inconspicuous regional characteristics, gender and age susceptibility differences, and occupational differences. Meanwhile, COVID-19 significantly reduced OID incidence in 2020. The discoveries might bring a beneficial effect on OID prevention and control policies.

A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in end-stage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P.001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.

The infection rate is high in patients injured at sea, and because of the unique distribution of marine microorganisms, the infection is often not easily controlled effectively with the empirical application of antibiotics. This study aims to consider the clinical characteristics and pathogen infection and drug susceptibility of patients injured at sea. From 2019 to 2021, there were 635 patients injured at sea in Rizhao People's Hospital. We assess the patient's basic condition, while performing bacterial culture and drug susceptibility testing on wound exudate or pus from infected patients. Among the 635 patients injured at sea, 195 people were infected, and the infection rate was 30.71%. Infected patients are usually older, have longer prehospital visits, and have lower normal levels of red blood cells, hemoglobin, total protein, and albumin. The causes of injury in infected patients were mainly avulsion and puncture injuries, and the types of injuries were mainly bone fracture, vascular injury, and nerve injury. A total of 305 strains of pathogenic bacteria were cultured in 195 patients. Gram-negative bacteria accounted for 77.05% (235 strains), of which Proteus was the most. Gram-positive bacteria accounted for 22.95% (70 strains), of which Staphylococcus aureus was the most. Gram-negative bacilli were sensitive to aminoglycosides, lactam antibiotics, carbapenems antibiotics, sulfonamides, quinolones, fourth-generation cephalosporins, and antibacterial drugs containing enzyme inhibitors, while most of the bacteria were resistant to penicillins, first-generation cephalosporins, and second-generation cephalosporins. Gram-positive bacteria were sensitive to quinuptin/dafoptin, rifampicin, linezolid, gentamicin, tigacycline, and vancomycin but resistant to penicillin antibiotics. Due to the particularity of marine injuries, patients are prone to infection. Pathogen culture and drug sensitivity analysis play an important role in guiding antiinfective treatment for marine injured patients.

Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.After surgery, the patient's symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.

Rationale: The anaplastic lymphoma kinase (ALK) fusion has been identified to be a driver gene in lung cancer, and serves as important diagnostic and therapeutic targets. Owing to the advanced sequencing technologies, new partner genes of ALK have been constantly detected. Patient concerns: A 55-year-old Chinese woman went to our hospital because of cough and expectoration for 1 year. The patient had no fever, chest pain and hemoptysis. Diagnoses: She was diagnosed with lung adenocarcinoma. Because she had no operational condition, combination chemotherapy with docetaxel and cisplatin (CP) for 4 cycles was adopted. However, computed tomography (CT) scan indicated progression disease (PD). To explore possibility of targeted therapy, the tumor samples were subjected to next-generation sequencing (NGS), and a rare double ALK fusion variant EML4-ALK and CDK15-ALK was identified. Interventions and outcomes: The patient subsequently received crizotinib treatment, and achieved partial response (PR). No significant drug related adverse reactions were found during crizotinib treatment. The progression-free survival achieved 23 months. Lessons: Together, we identified a rare double ALK fusion variant, EML4-ALK and CDK15-ALK, in a patient with lung adenocarcinoma. The patient benefited from crizotinib treatment, which could provide a certain reference for the patients with such gene alteration.

Background: Whether time of day has impact on outcomes after out-of-hospital cardiac arrest (OHCA) remains controversial. However, there are no evidence syntheses describing the impact of time differences on outcomes from OHCA. Methods: A meta-analysis of cohort studies exploring the association between time of day and survival in patients with OHCA was performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Ten studies involving 252,848 patients and 24,646 survivals were included. Patients with night-time OHCA had significantly lower short-term survival compared to patients with daytime OHCA (OR, 1.20; 1.07–1.36; P

Background: This systematic review will assess the effectiveness and safety neuromuscular electrical stimulation (NMES) for cancer pain (CP) in children with osteosarcoma. Methods: This systematic review protocol will retrieve the following electronic databases from inception to June 1 in Cochrane Library, MEDLINE, EMBASE, Web of Science, Scopus, CNKI, and VIP database. Manual head-searching of reference lists and conference proceedings will be performed to further examine the articles of interest. No restrictions will be applied to language and publication status. We will utilize a 3-stage approach to scan titles, abstracts, and full-text studies against all eligibility criteria, and collect data from included trials. Study quality will be evaluated by the Cochrane Risk of Bias Tool. If possible, we will narratively summarize study results and carry out meta-analysis. Results: This study will recapitulate the present high quality trials to appraise the effectiveness and safety of NMES for CP in children with osteosarcoma. Conclusion: The findings of this study will present evidence to determine whether NMES is effective and safe for CP in children with osteosarcoma.

The hypomethylation of the Cyclin D1 (CCND1) promoter induced by excess oxidative stress likely promotes the development of hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). We aimed to evaluate methylation status of the CCND1 promoter as a new plasma marker for the detection of HBV-HCC. We consecutively recruited 191 participants, including 105 patients with HBV-HCC, 54 patients with chronic hepatitis B (CHB), and 32 healthy controls (HCs). Using methylation-specific polymerase chain reaction, we identified the methylation status of the CCND1 promoter in plasma samples. We analyzed the expression levels of the CCND1 mRNA in peripheral blood mononuclear cells by using quantitative real-time PCR. We assessed the plasma levels of superoxide dismutase, 8-hydroxydeoxyguanosine and malondialdehyde by using enzyme-linked immunosorbent assays. Patients with HBV-HCC (23.81%) presented a reduced methylation frequency compared with patients with CHB (64.81%) or HCs (78.13%) (P

More and more studies have shown that cognitive dysfunction is one of the main complications of diabetes. The disorder of glucose and lipid metabolism seriously damages brain function and accelerates the conversion to dementia. At present, there are no drugs that can directly treat diabetic cognitive dysfunction. All drugs for the treatment of this disease achieve the purpose of treatment through strict control of blood sugar levels. This method has great limitations. Traditional Chinese patent medicines (TCPMs) work through multiple targets and multiple pathways, which can not only effectively correct the state of glucose and lipid metabolism disorders, but also significantly improve cognitive ability, but there is a lack of systematic evaluation of their effectiveness and safety. We use the method of network meta-analysis to systematically and comprehensively compare the effectiveness and safety of different Chinese patent medicines.We will comprehensively search the following databases, including Web of Science, PubMed, The Cochrane Library, EMBASE, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Wanfang database and China BioMedical Literature. We will include all randomized controlled trials that meet the inclusion criteria, starting from the establishment of the database until September 2021. Two researchers will independently screen the literature based on inclusion criteria. While extracting data, we also assess the risk of bias in the included studies. All the data and evidence obtained will be evaluated by the method of Bayesian network meta-analysis.This study will evaluate the effectiveness and safety of various TCPMs for diabetic cognitive dysfunction.The results of this study will provide valuable references for the clinical application of TCPMs, and assist clinicians in formulating more reasonable diagnosis and treatment strategies.This study does not require ethical approval.INPLASY202190008.

Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The purpose of this study was to evaluate the efficacy and safety of fire needle in the treatment of RAS.PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched by 2 reviewers from the inception until December 2021. The original study that randomized control trials of fire needle for RAS will be selected and is not limited by country or language. In addition, researches in progress, the reference lists and the citation lists of identified publications will be retrieved similarly. Study selection, data extraction, and assessment of the quality will be performed independently by 2 reviewers who have been trained prior to data extraction. A meta-analysis will be conducted if the quantity and quality of the original studies included are satisfactory; otherwise, a descriptive analysis will be conducted. Review Manager V5.4 software will be using for data synthesis and assessment of the risk of bias according to Cochrane Handbook.This study will provide a comprehensive review of current evidence for the treatment of fire needle on RAS.The conclusion of this study will provide a judging basis that whether the treatment of RAS with fire needle is effective.INPLASY2021120118.

Background: Type 2 diabetes is an independent risk factor for stroke. The main role of the current study is to study the mechanism of stroke induced by diabetes, but there is no systematic summary of daily management and stroke prevention for patients with type 2 diabetes. In order to provide a more detailed stroke prevention program for patients with type 2 diabetes, we included in the study and looked forward to analyzing the risk factors that were more in line with the clinical characteristics of type 2 diabetes. Methods: We will search the following Chinese and English databases: PubMed, Web of science, Cochrane Library, Medline, and China National Knowledge Infrastructure database. All of the above electronic databases will be searched from inception to June 30, 2021. In addition, we will manually search for conference papers, ongoing experiments, and internal reports to supplement the studies retrieved via electronic search. We will use the STATA 16.0 provided by Cochrane Collaboration Network for statistical analysis. Results: The study will prove a collective view on the relationship between related factors and stroke in the type 2 diabetes population. Conclusion: We plan to submit this systematic review to a peer-reviewed journal. INPLASY registration number: INPLASY2021100046

Whether programmed death-ligand 1 (PD-L1) expression could predict the outcome of tyrosine kinase inhibitor (TKI) treatment and prognosis of epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC) is remaining controversial. Potential studies were search from PubMed, Embase, and Web of Science databases. Pooled odds ratio of objective response rate was used to describe the relationship between PD-L1 expression and primary resistance to EGFR-TKIs. Pooled hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS) were included to assess the effects of PD-L1 status on the outcome of EGFR-TKI treatment and survival of EGFR-mutant NSCLCs. Eighteen eligible studies (1986 EGFR-mutant NSCLCs) were included in this meta-analysis. Positive PD-L1 expression correlated with lower objective response rate of EGFR-TKI treatment (odds ratio [95% confidence interval {CI}] = 0.52 [0.28–0.98], P = .043), while PFS (adjusted HR [95% CI] = 1.49 [0.96–1.89], P = .332) and OS (HR [95% CI] = 1.24 [0.70–2.20], P = .456) of EGFR-TKI treatment did not correlated with PD-L1 status. Furthermore, PD-L1 expression was not a predictive biomarker for the OS (HR [95% CI] = 1.43 [0.98–2.08], P = .062) in overall EGFR-mutant cohort. Positive PD-L1 expression indicated a higher incidence of primary resistance, but did not correlate with the PFS or OS of EGFR-TKI therapy. In addition, PD-L1 expression was unlikely a predictive biomarker for prognosis of EGFR-mutant NSCLCs.

Rationale: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important treatment for hematological malignancies. Common complications are opportunistic infections and graft-versus-host disease (GVHD). Cytomegalovirus (CMV) is one of the most common causes of opportunistic infections. Patient concerns: A 30-year-old male was diagnosed with T-cell lymphoma after persistent cough and lymphadenopathy. Fever, abdominal pain, diarrhea, rash, and dyspnea occurred after HSCT. Diagnosis: The young man developed severe CMV infection with CMV detected in the bronchoalveolar lavage fluid and gastrointestinal tract. Interventions: Intravenous ganciclovir and high-dose glucocorticoids were administered after the patient was diagnosed with CMV pneumonia and enteritis. Outcomes: After 3 weeks, the young man died from respiratory failure and infectious toxic shock caused by severe CMV infection. Lessons: Patients after HSCT should be closely monitored CMV-DNA in blood and other specimen, and treated first if necessary, so as to avoid the occurrence of severe infections such as CMV gastroenteritis and pneumonia.

Rationale Patients with lung adenocarcinoma harboring EML4-ALK rearrangements respond well to multiple ALK tyrosine kinase inhibitors (TKIs). However, the tumor will invariably progress due to acquired resistance. Comprehensive genomic profiling appears to be a promising strategy to reveal the underlying molecular mechanisms of ALK-TKIs resistance. Patient concerns A patient with right lung adenocarcinoma harboring an ALK rearrangement received targeted therapy with multiple ALK-TKIs. He sought for follow-up treatment after his disease progressed again. Diagnosis The patient had a tumor diagnosed with stage I (T1bN0M0) lung adenocarcinoma. Interventions Due to the surgical contraindication, the patient did not undergo surgical resection. Instead, he received crizotinib as the first-line therapy with the progression-free survival of 20 months. Then he switched to alectinib treatment, however the disease rapidly progressed again. Outcomes Next-generation sequencing was performed and revealed that 7 somatic mutations were identified. Among them, 2 mutations, ALK I1171T and BRAF V600E, may be responsible for the resistance of this patient to ALK-TKIs. BRAF V600E mutation may explain the patient's resistance to lorlatinib. Lessons We present a case of ALK-rearranged lung adenocarcinoma with acquired resistance to ALK inhibition, in which the BRAF V600E mutation is a novel resistance mechanism. This provides evidence that BRAF V600E mutation is one mechanism of ALK-TKI resistance.

Background Obesity has become the most serious public health problem in developed and developing countries, and simple obesity accounts for approximately 95% of the total cases. This study aims to assess the effects and safety of massage therapy for the treatment of simple obesity. Methods We will search foreign and Chinese databases, including PubMed, EMBASE, MEDLINE, CENTRAL, CNKI, WanFang Data, CBM, and VIP from the inception of the coverage of these databases to July 2020. Cochrane's collaboration tool will be used to assess the quality of the studies. RevMan 5.3 software will be used for the data analysis. Results This study will evaluate whether massage therapy is an effective intervention for simple obesity. Conclusion This study will provide evidence regarding whether massage therapy is beneficial for treating simple obesity in humans. Prospero registration number NO.CRD42020197635.

Rationale: This study aimed to investigate the genetic mutation characteristics of congenital idiopathic hypogonadotropic hypogonadism (IHH) through the clinical features and genetic analysis of 2 patients with IHH in 1 pedigree. Patient concerns: A 23-year-old girl presented with primary amenorrhea, sparse pubic hair, lack of breast development, and delayed sexual development. Diagnoses: Combined with the clinical characteristics, auxiliary examinations, and molecular genetic analysis, the patient was diagnosed as IHH. Interventions: Whole exome and Sanger sequencing were performed to validate the mutation in family members. Outcomes: A novel homozygous missense mutation c.521A > G (p.Q174R) in the GNRHR gene was identified in the 2 affected sisters. Familial segregation showed that the homozygous variant was inherited from their parents respectively and the eldest sister was the carrier without correlative symptom. Lessons: We reported a novel GNRHR mutation in a pedigree with congenital idiopathic hypogonadotropic hypogonadism. Glutamine at amino acid position 174 was highly conserved among various species. The molecular structure of GNRHR protein showed that p.Q174R mutation brought in a new stable hydrogen bond between position 174 and 215, may impede conformational mobility of the TMD4 and TMD5. It suggests that the missense mutation c.521A > G related to congenital idiopathic hypogonadotropic hypogonadism was probably a causative factor for both sisters. Through high-throughput sequencing and experimental verification, we had basically determined the patient's pathogenic mutation and inheritance, which could better guide doctors for treatment.

To explore the effect and mechanism of Shenfu Injection on serum metabolomics in laparoscopic hysterectomy. 1.5 mL/kg Shenfu injection was added to inject 200 mL of normal saline after the patients who entered the standard were admitted to the operating room. NMR metabolomics were performed at each time point before anesthesia (T0), immediately after pneumoperitoneum (T1), and at the end of surgery (T2). Multivariate trajectory analysis showed that SFI treatment could make laparoscopic hysterectomy interfere with the recovery of plasma metabolites to normal metabolic state, with a time-dependent trend. In addition, the key metabolic changes of laparoscopic hysterectomy at different stages of SFI treatment involve energy metabolism, oxidative stress response, amino acid metabolism, and pyruvate metabolism. Especially, the important role of SFI in the treatment of laparoscopic hysterectomy is antioxidant capacity. The results show that SFI can be used as a potential drug for laparoscopic hysterectomy. The current findings provided, for the first time, sound evidence of the protective effects of SFI on laparoscopic hysterectomy from both biochemical and metabolomics perspectives. The mechanisms of SFI could be related to regulating amino acid metabolism, pyruvate metabolism, and energy metabolism. The present study lays an important foundation for further research and for the broad clinical application of SFI.

Introduction: Hyperthyroidism-related anterior circulation ischemic events have been well documented; however, posterior circulation infarction is rarely reported, not to mention with superior mesenteric artery syndrome (SMAS), which has never been reported concurrently. We describe, to the best of our knowledge, the first case of hyperthyroidism-related cerebellar infarction accompanied with SMAS. Patient concerns: A 22-year-old women presented with palpitation, postprandial vomiting, and acute body weight loss. Enlarged thyroid gland was discovered in physical examination and Graves disease was diagnosed by blood test; therefore, Propylthiouracil and β-blocker were prescribed. Sudden onset conscious disturbance accompanied with apnea was noted during hospitalization. Diagnosis: Computed tomography (CT) revealed cerebellar infarction with severe cerebellar swelling and tonsil herniation; hence, emergent suboccipital craniotomy and bilateral tonsillectomy were performed. Interventions: Nevertheless, persisted poor passage of liquid diet during nasogastric tube feeding was noted after operation. CT of abdomen showed a sharp aorta-SMA angle (15°) and a short distance between aorta and SMA (6 mm) indicating a diagnosis of SMAS. Outcomes: After parental nutrition supplement and progressive rehabilitation program, she recovered to a modified Rankin Scale of 3. Conclusion: Although rarely reported, hyperthyroidism-related sympathetic hyperstimulation, vasculopathy could result in potentially deadly posterior circulation infarction. Furthermore, SMAS should be considered in the cases of hyperthyroidism with prolonged gastrointestinal symptoms even after treatment and should be treated simultaneously, since SMAS exacerbates depletion of intravascular volume. Further study to clarify the relation between hyperthyroidism and posterior circulation hemodynamic status is suggested.

Background: Recently, increased expression of TET1 has been shown to inhibit tumor development in many studies. Therefore, a meta-analysis was conducted to assess the prognostic role of TET1 in solid tumors. Methods: PubMed, Embase, and the Web of Science (last updated on June 13, 2019) were searched and 16 eligible studies involving 3100 patients were eventually taken forward into the meta-analysis. Results: Pooled results indicated that higher TET1 expression in cancer tissues was associated with improved overall survival (OS) [hazard ratio (HR) = 0.736, 95% confidence interval (95% CI) = 0.542–0.998, P = .049]. In the subgroup analysis, higher TET1 expression in respiratory tumors (HR = 0.778, 95% CI = 0.639–0.946, P = .012) and breast cancer in Asian patients (HR = 0.326, 95% CI = 0.199–0.533, P

Rationable: Large cell neuroendocrine carcinoma of the lung is rare, especially in the area of the foramen magnum. No previous studies have reported metastatic large cell neuroendocrine lung cancer to the foramen magnum. This paper will be the first time to report this special case. Patient concerns: A case of a 37-year-old woman presented with headache that had developed 20 days previously. Imaging examination revealed a circular abnormal signal at the posterior margin of the foramen magnum. Diagnoses: The patient we report was diagnosed with a metastatic intracranial tumor. Interventions: The patient underwent occipital craniotomy. Pathological results showed metastatic neuroendocrine carcinoma of the brain. Whole body PET-CT examination showed that fusiform soft tissue shadows could be seen near the hilum of the lower lobe of the left lung. Outcomes: The final bronchoscopy pathological results showed the large cell neuroendocrine carcinoma of the lung. The patient underwent further chemotherapy and radiotherapy in the oncology department. Lessons: Diagnosis and treatment of large cell neuroendocrine carcinoma of the lung are difficult. The prognosis is poorer, and effective treatment is urgently needed.

Background: The objective of this study is to examine the effectiveness and safety of electroacupuncture (EA) in the treatment of urinary incontinence (UI) in patients with spinal cord injury (SCI). Methods: All potential studies will be retrieved from the electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, CBM, and China National Knowledge Infrastructure from origin of each database up to January 31, 2020. Additionally, we will check other resources, such as Google scholar, dissertations, conference proceedings, and reference lists of included studies. No language and publication date limitations will be considered in the literature resources search. All randomized controlled trials using EA for the treatment of UI in patients with SCI will be included. Two independent investigators will perform study selection, data extraction and study quality assessment. If any conflicts occur, we will invite a third investigator to solve them. Cochrane risk of bias will be used for study quality assessment, and RevMan 5.3 software will be employed for statistical analysis. Results: This study will summarize the most recent evidence to assess the effectiveness and safety of EA for the treatment of UI in patients with SCI. Conclusion: The results of this study will provide helpful evidence to determine whether EA is effective and safety for the treatment of UI in patients with SCI or not. PROSPERO registration number: PROSPERO CRD42020165562.

Introduction: Although the current western treatment plans for unstable angina (UA) has been optimized in past decades, UA still is a common phenotype of acute coronary syndrome and significantly influence the quality of life and endanger lives. In China, the clinical application of Chinese herb medicine is considered as an effective approach to treating UA and widely recognized by patients. In clinical practices, we found Luofengning granule (LFN-G) could improve clinical manifestations of patients with UA, but there is lack of rigorous proof of evidence-based medicine. This trial aims to further evaluate the efficacy of LFN-G in the treatment of UA. Methods: A prospective, open-label, randomized, placebo-controlled clinical will be performed. A total of 60 patients diagnosed with UA will be randomly allocated to either the treatment group or the control group with a 1:1 ratio. The participants in the treatment group will receive LFN-G treatment and the participants in the control group will receive placebo. Meanwhile, both groups continue to undergo standard western medicine treatments. The duration of interventions is 4 weeks. The primary endpoint is the incidence of major cardiac adverse events, defined as a composite of recurrent angina, acute myocardial infarction (AMI), severe arrhythmia, heart failure, and cardiac death. Secondary outcomes include Seattle angina scale score, Chinese medicine syndromes and electrocardiograph (at weeks 0, 1, 2, 4), myocardial nuclides perfusion, measurement of wall motion score index and left ventricular ejection fraction, serum inflammation factors such as C-reactive protein, high sensitive-C-reactive protein, interleukin-6, matrix metalloproteinase-9, and so on (at weeks 0, 4). In addition, some biochemical indexes of blood and hematological indexes will be used to assess the safety of treatments. Any adverse effects of the treatment will be recorded. Discussion: The results of this trial will provide compelling evidence of the efficacy and safety of LFN-G for treatment of UA and preliminarily reveal the potential mechanism of how LFN-G acts. Finally, it will widen treatment options for patients with UA.

Insomnia patients with different gender and age usually had different sleep experience. Primary insomnia (PI) has been considered to be a disorder of hyper-arousal in the physiologic, emotional, or cognitive network. Although the hyper-arousal brain regions can be shown by comparing the brain activity of PI patients with normal people at rest, whether the brain activity of PI patients varied according to age and gender and whether age and gender could affect the distribution of hyper-arousal brain regions are still worthy of further exploration. Hence, a resting state functional magnetic resonance imaging study (No. NCT02448602) was designed to observe the brain activity of thirty PI patients and 15 healthy controls (HCs). The brain activity in resting state was measured by calculating the fractional amplitude of low-frequency fluctuations (fALFF), which reflected the idiopathic activity level of neurons. Multiple regression was performed to investigate the age and gender-related differences of brain activity in PI patients (P 50) with age and gender as covariates. The hyper-arousal brain regions were measured by comparing the fALFF of PI patients and HCs. Multiple regression (P 50) was also performed for PI patients and HCs with group, age, and gender as covariates.The results suggested that the gender-related difference of brain activity mainly existed in superior temporal gyrus, cerebellum posterior lobe, middle frontal gyrus, and the age-related difference mainly existed in cerebellum anterior lobe, superior temporal gyrus, brainstem, parahippocampa gyrus, anterior cingulate, cingulate gyrus. In addition, the altered fALFF regions between PI and HCs mainly existed in superior temporal gyrus, posterior cingulate, anterior cingulate, cingulate gyrus, middle frontal gyrus. Furthermore, the gender factor could not influence the distribution of the altered regions. While the age factor could affect the distribution of the altered regions.

The stimulator of interferon genes (STING) plays a crucial role in the recognition of a viral infection and subsequent stimulation of an immune response. However, it is unclear whether methylation of the STING promoter affects STING transcription and response to antiviral therapy. The present study determined the methylation status of the STING promoter in patients with chronic hepatitis B (CHB). This study included 198 participants, of which 159 participants had CHB and 39 were healthy controls (HCs). Methylation-specific polymerase chain reaction was performed to detect the methylation status of the STING promoter. Reverse transcription-quantitative polymerase chain reaction was performed to determine STING mRNA level in peripheral blood mononuclear cells. The methylation frequency of the STING promoter was significantly higher and STING mRNA level was lower in the patients with CHB than in the HCs. Presence of hepatitis B virus (HBV) DNA was independently correlated with an increased risk of STING promoter methylation. Virological response frequency was higher in the patients with CHB receiving entecavir (ETV) than in those receiving adefovir (ADV). In the ETV group, the virological response frequency was evidently lower in the patients with CHB having methylated STING promoters than in those having unmethylated STING promoters. However, there was no significant difference in the virological response frequency between ADV-treated patients having methylated and unmethylated STING promoters. These results indicate that the hypermethylation of the STING promoter and thus the transcriptional repression of STING weaken the effect of STING in inhibiting HBV replication and decreases the effectiveness of antiviral therapy.

Supplemental Digital Content is available in the text, Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve postoperative fever, surgery pain, and inflammation. In addition, NSAIDs have anticancer activity and may reduce the risk and mortality of several cancers. However, the association between postoperative NSAIDs and the clinical outcome of non-small cell lung cancer (NSCLC) patients with fever after surgery is not fully understood. We performed a retrospective study of NSCLC patients who underwent surgery between July 2011 and June 2012, aiming to evaluate the effect of postoperative NSAIDs on overall survival (OS) and progression-free survival (PFS). Differences in clinical data between the postoperative NSAIDs group and non-NSAIDs groups were analyzed by Chi-square tests. Kaplan-Meier curves method and Cox regression analysis were conducted for survival analysis. The primary and secondary endpoints were OS and PFS, respectively. This retrospective study included 347 NSCLC patients. There were no significant differences in the clinical characteristics between the NSAIDs group and non-NSAIDs group except for age (P = .024) and differential degree (P = .040). Administration of postoperative NSAIDs was related to longer OS (hazards ratio [HR] 0.528, 95% confidence interval [CI] 0.278–0.884, P = .006) and longer PFS (HR 0.557, 95% CI 0.317–0.841, P = .002) in the multivariate Cox regression model. Subgroup analysis showed statistically significant differences in elderly individuals, male subjects, low smoking index, poor differentiation, and non-adenocarcinoma subgroups, respectively. In conclusion, the administration of postoperative NSAIDs was related to longer OS and PFS in NSCLC patients with postoperative fever.

To investigate the correlation between echinodermmicro tubule associated protein-like 4 (EML4)-anaplasticlymphomakinase (ALK), epidermal growth factor receptor (EGFR) and clinicopathological features in patients diagnosed with lung adenocarcinoma according to International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) international multidisciplinary classification of lung adenocarcinoma. Ninety patients diagnosed with lung adenocarcinoma underwent surgical pathological classification. Ventana immunohistochemical staining of the EML4-ALK was performed. The mutation of EGFR and EML4-ALK was detected by real-time polymerase chain reaction (RT-PCR) using the amplification refractory mutation system. The positive rate of EML4-ALK mutation was calculated as 6.7% (6/90), dominantly occurring in patients aged

Our study aimed to evaluate the utility of muscle ultrasound in newborn screening of infantile-onset Pompe disease (IOPD) and to establish a system of severity grading. We retrospectively selected 35 patients with initial low acid alpha-glucosidase (GAA) activity and collected data including muscle ultrasound features, GAA gene mutation, activity/performance, and pathological and laboratory findings. The echogenicity of 6 muscles (the bilateral vastus intermedius, rectus femoris, and sartorius muscles) was compared to that of epimysium on ultrasound and rated either 1 (normal), 2 (mildly increased), or 3 (obviously increased). These grades were used to divide patients into 3 groups. IOPD was present in none of the grade-1 patients, 5 of 9 grade-2 patients, and 5 of 5 grade-3 patients (P

Laparoscopic-assisted rectal resection (LAR) has been widely used to treat rectal cancer. However, it has a steep learning curve. In this study, we aimed to investigate the effects of the learning curve on the outcomes of LAR. All consecutive patients with rectal cancer undergoing LAR or open resection (OR) between 2010 and 2015 were included in this retrospective analysis. The learning curve was determined, and patients were divided into 2 phases: the learning curve and the expert period. The short-term perioperative data in the 2 phases and the long-term survival in the learning phase were compared between the LAR and OR groups. A total of 491 patients were included in this study. Inflection of the learning curve based on the operation time of LAR was at the 40th case. A total of 233 patients underwent surgery (112 LAR and 121 OR) during the learning period. In this period, LAR had a longer operation time, less blood loss, and a higher total cost (all P

Background The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP. Methods A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used. Results A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88-2.41; P = .14)], postoperative complications (RR = 0.81; 95% CI = 0.58-1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75-1.33; P = .99), operative time (MD = 1.60; 95% CI = -1.36-4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19-2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = -2.01; 95% CI = -3.15 to -0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07-0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71-0.97; P = .02) compared with the DLC group. Conclusion Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.

Obstructive sleep apnea (OSA) adversely affects neurological recovery. This study aimed to determine the impact of continuous positive airway pressure (CPAP) and/or rehabilitation in basal ganglia stroke patients with OSA.A prospective controlled trial was conducted in 2015-2018. The subjects received routine rehabilitation training for up to 2 years and were assigned to the intervention and control groups treated with CPAP or without, respectively. Then, treatment effects on sleep parameters, motor function, stroke severity, daily life activities, cognitive function, and psychological states were assessed at different time points.At 6 months, the CPAP group showed significantly lower mean apnea-hypopnea index (AHI), percentage of time with SpO2 at .05). Repeated-measures ANOVA revealed significant interactions between the two groups for change in FMA, MMSE, BI, HAMA, and HRSD scores from admission to 24 months (P < .001), but no significant was found for BMI (P = .582).Basal ganglia stroke patients with OSA tend to have significantly greater sleeping, neurological and functional recovery after CPAP, and rehabilitation over 2 years.

ON1 is a novel genotype of human respiratory syncytial virus (HRSV) subtype A, in children with acute respiratory tract infections (ARTIs). However, there is not much data on the prevalence and clinical and molecular characterization in China. Our study is based on the children who had respiratory infections positive for RSV-A admitted by Gansu Provincial Maternity and Child-care Hospital in Lanzhou (northwestern China) during the last 7 epidemic seasons from 2010 to 2017. In our study, different strains of the novel RSV-A genotype ON1, first identified in Canada in December 2010, were first detected in Gansu Provincial Maternity and Child-care Hospital in August 2012 and then followed by an abrupt expansion in the number of ON1 variants in the beginning of 2014 and eventually replaced all other RSV-A strains from 2015 to 2017. ON1 is characterized by a 72-nt duplication in the C-terminal region of the highly variable attachment glycoprotein (G), predicted to lengthen the polypeptide with 24 amino acids, including a 23-aa duplication, which likely changes antigenicity. New N-glycosylation sites occurred within the 23-aa duplication and 24-aa insertion of the ON1 viruses in our study. Notably, RSV infections occurred later, but peaked sooner from the 2014/2015 to 2016/2017 epidemic seasons, compared with the previous 4 seasons. Our study concluded that genotype ON1 has caused larger outbreaks and became the predominate genotype for HRSV subgroup A in Lanzhou from 2013 to 2017, and became the sole genotype of RSV-A in 2015/2016 and 2016/2017. Our data indicate that northwest of China and the world will eventually be dominated by the ON1 RSV-A genotype, including the possibility for vaccine development. Based on trends seen in RSV-B BA genotype, which predominated for decades, there is a possibility to develop a vaccine for children in the next 10 years.

Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup.We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors' institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared.Patients in the study group were younger than those in the control group (38 [25-60] vs 54.5 [19-88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155-360] vs 225 [25-480] minutes, P = .041) was longer and symptom onset (1.0 [0-6] vs 1.0 [0-6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59).Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population.

To assess the clinicopathologic features, differential diagnosis, and pathogenesis of sclerosing angiomatoid nodular transformation (SANT) of the spleen.The clinical characteristics of 7 cases with SANT were retrospectively analyzed. Histochemical and immunohistochemical (EnVision method) ex