Medicine最新文献

{"title":"Relationship between monocyte/lymphocyte ratio and non-culprit plaque vulnerability in patients with acute coronary syndrome: An optical coherence tomography study.","authors":"Ting-Yu Zhang,&nbsp;Qi Zhao,&nbsp;Ze-Sen Liu,&nbsp;Chao-Yi Zhang,&nbsp;Jie Yang,&nbsp;Kang Meng","doi":"10.1097/MD.0000000000021562","DOIUrl":"https://doi.org/10.1097/MD.0000000000021562","url":null,"abstract":"<p><p>The importance of monocyte/lymphocyte ratio (MLR) has been indicated in the initiation and progression of coronary artery disease. However, few previous researches demonstrated the relationship between MLR and plaque vulnerability. We aimed to investigate coronary non-culprit plaque vulnerability in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT).A total of 72 ACS patients who underwent coronary angiography and OCT test in Beijing Anzhen Hospital were included in this retrospective study. The plaque vulnerability and plaque morphology were assessed by OCT.The non-culprit plaque in high MLR group exhibited more vulnerable features, characterizing as thinner thickness of fibrous cap (P = .013), greater maximum lipid core angle (P = .010) and longer lipid plaque length (P = .041). A prominently negative liner relation was found between MLR and thickness of fibrous cap (R = -0.225, P = .005). Meanwhile, the proportion of OCT-detected thin cap fibro-atheroma (TCFA) (P = .014) and plaque rupture (P = .017) were higher in high MLR group. Most importantly, multivariable logistic regression analysis showed MLR level was identified as an independent contributor to the presence of TCFA (OR:3.316, 95%: 1.448-7.593, P = .005). MLR could differentiate TCFA with a sensitivity of 60.0% and a specificity of 85.1%.Circulating MLR level has potential value in identifying the presence of vulnerable plaque in patients with ACS. MLR, as a non- invasive biomarker of inflammation, may be valuable in revealing plaque vulnerability.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e21562"},"PeriodicalIF":1.6,"publicationDate":"2020-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000021562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38466967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to improve physical performances of older people with cancer before complex medico-surgical procedures: Protocol for an umbrella review of systematic reviews and meta-analyses.","authors":"Claire Falandry,&nbsp;Laetitia Stefani,&nbsp;Louise Andre,&nbsp;Marion Granger,&nbsp;Claire Barbavara,&nbsp;Hocine Habchi,&nbsp;Chrystelle Bourgeois,&nbsp;Hervé Cure,&nbsp;Guillaume Passot,&nbsp;Thomas Gilbert","doi":"10.1097/MD.0000000000021780","DOIUrl":"https://doi.org/10.1097/MD.0000000000021780","url":null,"abstract":"<p><strong>Background: </strong>Current demographics lead increasing older cancer patients to undergo complex medico-surgical procedures, with substantial risk of decompensations and deconditioning. The Prehabilitation & Rehabilitation in Oncology: Adaptation to Disease and Accompaniment of Patients' Trajectories (PROADAPT) project is currently being developed with the aim of improving care, through standardized care pathways guided by existing evidence and implementation programs. A working group will specifically focus on improvement of physical performances before such procedures. These interventions may have been developed in different contexts: before surgery in large, before carcinologic surgery or complex medical interventions (chemotherapy, radiotherapy), or in primary care for elderly patients to prevent sarcopenia and frailty. Post-surgical interventions are out of the scope of this review. The objective of this review is to summarize the level of evidence to support physical reconditioning interventions and identify areas where further work is required.</p><p><strong>Methods: </strong>This umbrella review will include moderate to high quality systematic reviews, meta-analysis, and pre-existing umbrella or meta-reviews. Two reviewers will independently search the following databases: PubMed/MedLine, Cochrane Library, Embase, and CINAHL. Research strategy will use diverse keywords used to refer to the concepts of \"prehabilitation,\" \"preoperative exercise,\" or \"preoperative rehabilitation,\" with prespecified inclusion and exclusion criteria and only systematic reviews selection. The distinct types of interventions presented using PRISMA guidelines and a narrative reporting of results. A focus will be made on outcomes such as physical performances, quality of life, autonomy in everyday activities, or number of hospital bed days.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not required for such an umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. It will be complementary to reviews focused on hospital discharge of older people.</p><p><strong>Prospero registration number: </strong>CRD42020100110.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e21780"},"PeriodicalIF":1.6,"publicationDate":"2020-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000021780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38432941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy for gastric cancer peritoneal carcinomatosis: A protocol for systematic review and meta-analysis of randomized controlled trials.","authors":"Yidan Lu,&nbsp;Zheng Jin,&nbsp;Song Zheng,&nbsp;Yurong Bai,&nbsp;Yangcheng Sun","doi":"10.1097/MD.0000000000020973","DOIUrl":"https://doi.org/10.1097/MD.0000000000020973","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of gastric cancer peritoneal carcinomatosis (GCPC) remains poor despite recent advances in systemic chemotherapy (SC) with an average survival less than 6 months. Current evidence supporting the utility of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with SC for GCPC is limited. We plan to provide a systematic review and meta-analysis of randomized controlled trials to evaluate the comparative effects and safety of HIPEC combined with SC in the management of GCPC.</p><p><strong>Methods: </strong>Randomized controlled trials evaluating HIPEC combined with SC versus SC as first-line treatment for GCPC will be searched in MEDLINE, EMBASE, Web of Science, the Cochrane Library, ClinicalTrials.gov, and Google Scholar, from database inception to April 30, 2020. Data on study design, participant characteristics, intervention details, and outcomes will be extracted. Primary outcomes to be assessed are: median progression-free survival; secondary outcomes are: median survival time, 1- year survival rate, 2-year survival rate, objective response rate, and adverse events. Meta-analysis will be performed using RevMan V.5.3 statistical software. Data will be combined with a random effect model. Study quality will be assessed using the Cochrane Risk of Bias Tool. Heterogeneity will be assessed, and if necessary, a subgroup analysis will be performed to explore the source of heterogeneity.</p><p><strong>Results: </strong>The results will provide useful information about the effectiveness and safety of HIPEC combined with systemic chemotherapy regimens in patients with gastric cancer peritoneal carcinomatosis.</p><p><strong>Conclusion: </strong>The findings of the study will be disseminated through peer-reviewed journal.</p><p><strong>The registration number: </strong>INPLASY202050006.</p><p><strong>Doi number: </strong>10.37766/inplasy2020.5.0006.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e20973"},"PeriodicalIF":1.6,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000020973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38129025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral monocyte count is an independent predictor of all-cause mortality in type 2 diabetes with macro-vascular complications.","authors":"Lina Yang,&nbsp;Jinbo Hu,&nbsp;Zhihong Wang,&nbsp;Xiangjun Chen,&nbsp;Yue Wang,&nbsp;Shumin Yang,&nbsp;Ting Luo,&nbsp;Mei Mei,&nbsp;Qingfeng Cheng,&nbsp;Zhixin Xu,&nbsp;Zhipeng Du,&nbsp;Lilin Gong,&nbsp;Rong Luo,&nbsp;Qifu Li","doi":"10.1097/MD.0000000000018876","DOIUrl":"https://doi.org/10.1097/MD.0000000000018876","url":null,"abstract":"<p><p>The relationship between monocyte count and mortality seemed to be varied in different diseases, and it remains unclear in type 2 diabetes (T2D). We conducted a prospective study to investigate whether monocyte count predict all-cause mortality in patients with T2D.In this prospective study, a total of 1073 patients with T2D were enrolled at baseline and 880 patients completed the follow up. The median follow-up time was 47 months. At baseline, clinical characteristics including height, weight, waist circumference, blood pressure were recorded. Biochemical parameters including counts of white blood cells (WBCC), neutrophil (NC) and monocyte (MC), lipid profiles, glycated hemoglobin (HbA1c), serum creatinine were measured. Charlson comorbidity index (CCI) was calculated based on age and comorbidities. Participants were stratified into low, median, and high tertiles according to the baseline MC. Regression models were used to analyze the associations of peripheral MC and the all-cause mortality.Compared to the survived subjects, the baseline MC was significantly higher in patients who deceased during the follow-up (0.45 ± 0.16 vs 0.37 ± 0.15 × 10/L, P = .003). In the multivariate Cox hazard models, subjects in higher MC tertile showed higher risks of all-cause mortality (low tertile as the reference, hazard ratio [HR] 95%CI 2.65 [0.84,8.31] and 3.73 [1.14,12.24] for middle and high MC tertile, respectively) after adjusted for gender, body mass index, CCI, duration of T2D, history of hypertension and metabolic syndrome, drugs, levels of high-sensitivity C-reactive protein, systolic blood pressure, HbA1c, WBCC, and NC. In T2D patients with macro-vascular complications at baseline, 1-SD increment of MC resulted in 1.92-fold higher risk of all-cause mortality. However, the relationship disappeared in subjects without macro-vascular complications at baseline (1.13 [0.72, 1.78], P = .591).Peripheral monocyte count is an independent predictor of all-cause mortality in T2D, especially for subjects with macro-vascular complications.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e18876"},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000018876","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37574794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic resistance profiles and multidrug resistance patterns of Streptococcus pneumoniae in pediatrics: A multicenter retrospective study in mainland China.","authors":"Cai-Yun Wang,&nbsp;Ying-Hu Chen,&nbsp;Chao Fang,&nbsp;Ming-Ming Zhou,&nbsp;Hong-Mei Xu,&nbsp;Chun-Mei Jing,&nbsp;Hui-Ling Deng,&nbsp;Hui-Jun Cai,&nbsp;Kai Jia,&nbsp;Shu-Zhen Han,&nbsp;Hui Yu,&nbsp;Ai-Min Wang,&nbsp;Dan-Dan Yin,&nbsp;Chuan-Qing Wang,&nbsp;Wei Wang,&nbsp;Wei-Chun Huang,&nbsp;Ji-Kui Deng,&nbsp;Rui-Zhen Zhao,&nbsp;Yi-Ping Chen,&nbsp;Ji-Hong Yang,&nbsp;Chun Wang,&nbsp;Yan-Ran Che,&nbsp;Xiu-Zhen Nie,&nbsp;Shi-Fu Wang,&nbsp;Jian-Hua Hao,&nbsp;Cong-Hui Zhang","doi":"10.1097/MD.0000000000015942","DOIUrl":"https://doi.org/10.1097/MD.0000000000015942","url":null,"abstract":"<p><p>Emergent resistance to antibiotics among Streptococcus pneumoniae isolates is a severe problem worldwide. Antibiotic resistance profiles for S pneumoniae isolates identified from pediatric patients in mainland China remains to be established.The clinical features, antimicrobial resistance, and multidrug resistance patterns of S pneumoniae were retrospectively analyzed at 10 children's hospitals in mainland China in 2016.Among the collected 6132 S pneumoniae isolates, pneumococcal diseases mainly occurred in children younger than 5 years old (85.1%). The resistance rate of S pneumoniae to clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole was 95.8%, 95.2%, 93.6%, and 66.7%, respectively. The resistance rates of S pneumoniae to penicillin were 86.9% and 1.4% in non-meningitis and meningitis isolates, while the proportions of ceftriaxone resistance were 8.2% and 18.1%, respectively. Pneumococcal conjugate vaccine was administered to only 4.1% of patients. Penicillin and ceftriaxone resistance, underling diseases, antibiotic resistant risk factors, and poor prognosis appeared more frequently in invasive pneumococcal diseases. The incidence of multidrug resistance (MDR) was 46.1% in patients with invasive pneumococcal disease which was more than in patients with non-invasive pneumococcal disease (18.3%). Patients with invasive pneumococcal disease usually have several MDR coexistence.S pneumoniae isolates showed high resistance to common antibiotics in mainland China. Penicillin and ceftriaxone resistance rate of invasive streptococcal pneumonia patients were significantly higher than that of non-invasive S pneumoniae patients. Alarmingly, 46.1% of invasive clinical isolates were multidrug resistant, so it is important to continued monitor the resistance of S pneumoniae when protein conjugate vaccine (PCV13) is coming in mainland China.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e15942"},"PeriodicalIF":1.6,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000015942","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37326469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polymer-free drug-eluting stents versus permanent polymer drug-eluting stents: An updated meta-analysis.","authors":"Yun-Lin Chen,&nbsp;Jinqi Fan,&nbsp;Guozhu Chen,&nbsp;Li Cao,&nbsp;Li Lu,&nbsp;Yanping Xu,&nbsp;Yuehui Yin","doi":"10.1097/MD.0000000000015217","DOIUrl":"https://doi.org/10.1097/MD.0000000000015217","url":null,"abstract":"<p><strong>Background: </strong>Polymer-free drug-eluting stents (PF-DES) have been demonstrated comparable to permanent polymer drug-eluting stents (PP-DES) during long-term follow-up. As a critical component of drug-eluting stents, antiproliferative drugs may be a confounding factor for the results. Thus, we sought to compare the outcomes of these stents during long-term follow-up, especially in consideration of different stent platforms with the same drugs.</p><p><strong>Methods: </strong>A systemic search was performed to identify the related randomized controlled trials comparing PF-DES with PP-DES. Primary outcomes included short (≤1 year) and long-term (>1 year) target lesion revascularization (TLR), short-term in-stent late luminal loss (LLL) and diameter stenosis (DS). Subgroup analyses stratified by the different platforms with the same proliferative drugs were conducted in TLR, LLL, and DS. Standardized mean differences (SMDs) and risk ratios (RRs) were estimated using fixed /random effects models RESULTS:: A total of 6927 patients extracted from 12 RCTs were enrolled in the meta-analysis. No differences were observed in clinical outcomes of short-term and long-term overall mortality, myocardial infarction and stent thrombosis and angiographic outcomes of short-term in-stent LLL and DS between PF-DES and PP-DES for patients with coronary artery lesions. Nevertheless, compared with PP-DES coated with the same proliferative drugs, PF-DES had significantly increased risks of in-stent LLL (SMD, 0.49; 95% confidence interval [CI], 0.25-0.72) and DS (SMD, 0.67; 95% CI, 0.27-1.07), and long-term TLR (RR, 1.64; 95% CI 1.13-2.39). There were no significant differences in other outcomes.</p><p><strong>Conclusions: </strong>Under the condition of using same antiproliferative drugs (paclitaxel or sirolimus) in different stent systems, PF-DES are associated with the increased risk of restenosis compared to PP-DES.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e15217"},"PeriodicalIF":1.6,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000015217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37155038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonalcoholic fatty liver disease represents a greater metabolic burden in patients with atherosclerosis: A cross-sectional study.","authors":"Jie Han,&nbsp;Yong Wang,&nbsp;Zhongshang Yuan,&nbsp;Lu Liu,&nbsp;Meng Zhao,&nbsp;Qingbo Guan,&nbsp;Haiqing Zhang,&nbsp;Qiu Li,&nbsp;Jin Xu,&nbsp;Ling Gao,&nbsp;Jiajun Zhao,&nbsp;Xu Zhang","doi":"10.1097/MD.0000000000014896","DOIUrl":"https://doi.org/10.1097/MD.0000000000014896","url":null,"abstract":"<p><p>How nonalcoholic fatty liver disease (NAFLD) is linked to atherosclerosis is still disputed. This study aimed to explore the association between NAFLD and atherosclerosis among adults in Shandong province, China.A total of 6849 individuals were enrolled in the final analyses for a community-based study. The relationship between NAFLD and atherosclerosis was evaluated after adjusting for common confounding factors.Hypertension, diabetes, and higher serum low-density lipoprotein cholesterol (LDL-c) level were positively correlated with NAFLD. An odds ratio (OR) (95% confidence interval [CI]) of 1.325 (range 1.157-1.518) for hypertension, 2.153 (range 1.814-2.555) for diabetes, and 1.161 (range 1.071-1.259) for LDL-c was noticed. These factors also were positively correlated with atherosclerosis, with an OR (95% CI) of 1.501 (range 1.286-1.751) for hypertension, 1.716 (range 1.414-2.084) for diabetes, and 1.344 (range 1.231-1.466) for LDL-c. The prevalence of metabolic syndrome was higher in the atherosclerosis+NAFLD group (81.8%) when compared with the NAFLD-only (30.3%), atherosclerosis-only (32.2%), and control (20.3%) groups (P <.01).NAFLD and atherosclerosis have common metabolic characteristics, such as hypertension, diabetes, and higher serum LDL-c level. Patients with NAFLD in combination with atherosclerosis were found to have a more severe metabolic burden and greater chances of having hypertension, diabetes, dyslipidemia, and higher metabolic syndrome scores than those in the other groups.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e14896"},"PeriodicalIF":1.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000014896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37064849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary biliary cirrhosis with refractory hypokalemia: A case report.","authors":"Kai-Hui Dong,&nbsp;Yi-Na Fang,&nbsp;Xiao-Yu Wen,&nbsp;Qing-Long Jin","doi":"10.1097/MD.0000000000013172","DOIUrl":"https://doi.org/10.1097/MD.0000000000013172","url":null,"abstract":"<p><strong>Rationale: </strong>Renal tubular acidosis (RTA) represents a class of metabolic disorders characterized by metabolic acidosis with a normal plasma anion gap. As a rare complication of primary biliary cirrhosis (PBC), RTA is easily overlooked, likely leading to misdiagnosis.</p><p><strong>Patient concerns: </strong>A 32-year-old woman who had been diagnosed with PBC at our hospital was found to have hypokalemia due to repeated fatigue for 2 years, and the etiology was unknown.</p><p><strong>Diagnoses: </strong>Due to the laboratory test results, radiographic findings, and pathologic results, she was diagnosed with PBC associated with RTA.</p><p><strong>Interventions: </strong>She was then treated with ursodeoxycholic acid, potassium citrate, and calcium supplements together with activated vitamin D.</p><p><strong>Outcomes: </strong>Thus far, the patient showed a good response to ursodeoxycholic acid, and the clinical symptoms and liver function were significantly improved.</p><p><strong>Lessons: </strong>Physicians that encounter refractory hypokalemia in a patient with PBC should be aware of the presence of RTA. The early diagnosis and treatment of such patients are of paramount importance to alleviate clinical symptoms and delay disease progression.</p>","PeriodicalId":508590,"journal":{"name":"Medicine","volume":" ","pages":"e13172"},"PeriodicalIF":1.6,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MD.0000000000013172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36745042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}