Sirolimus plus prednisolone vs sirolimus monotherapy for kaposiform hemangioendothelioma: a randomized clinical trial

The Kasabach-Merritt phenomenon (KMP) in kaposiform hemangioendothelioma (KHE) is characterized by life-threatening thrombocytopenia and consumptive coagulopathy. This study compared the efficacy and safety of sirolimus plus prednisolone versus sirolimus monotherapy as treatment strategies for KHE with KMP in the largest cohort to date. Participants were randomized to receive either sirolimus in combination with a short course of prednisolone or sirolimus monotherapy for at least 12 months. The primary outcome was defined as achievement of a durable platelet response (platelet count >100×109/L) at week 4. Participants completed efficacy assessments 2 years after the initial treatment. At week 4, a durable platelet response was achieved by 35 of 37 patients given sirolimus and prednisolone compared with 24 of 36 patients given sirolimus monotherapy (difference 27.9%; 95% CI, 10.0% to 44.7%). Compared with the sirolimus monotherapy group, the combination treatment group showed improvements in terms of measures of durable platelet responses at all points during the initial 3-week treatment period, median platelet counts during weeks 1 to 4, increased numbers of patients achieving fibrinogen stabilization at week 4, and objective lesion responses at month 12. Patients receiving combination therapy had fewer blood transfusions and a lower total incidence of disease sequelae than patients receiving sirolimus alone. The frequencies of total adverse events and grade 3-4 adverse events during treatment were similar in both groups. The responses seen in patients with KHE with KMP were profound and encouraging, suggesting that sirolimus plus prednisolone should be considered a valid treatment for KHE with KMP. ClinicalTrial.gov, number NCT03188068

The Involvement of miRNAs in Pituitary Adenomas Pathogenesis and the Clinical Implications

Pituitary adenomas (PAs) account for the top three primary intracranial tumors in terms of total incidence rate. PAs can cause severe endocrine disorders and even malignant features, such as invasion, metastasis, and recurrence. Therefore, the early diagnosis and accurate prognosis would be greatly beneficial for clinical treatment of PAs. MicroRNAs (miRNAs) are small, protein-noncoding RNAs that regulate gene expression posttranscriptionally. They regulate essential physiological processes, including proliferation, growth, and apoptosis, and also they involve in the invasion and metastasis of malignant tumors. At the tissue level, differential miRNA expression in endocrine malignancies including PAs has been reported. When miRNAs have been successfully detected in various biofluids and cell-free environments, their important roles as potential screening or prognostic biomarkers have been extensively investigated. The current work reviews recent studies on the emerging roles of miRNAs in PAs and the clinical significance.

Incidences of Adverse Reactions in BNT162b2: A Meta-analysis

Review question / Objective: This study searched PubMed, Cochrane Library, Web of Science, Embase Electronics, and other databases to collect healthy adults aged 16 and older, subjects with no previous history of COVID-19 infection, A randomized controlled trial of Pfizer's vaccine BNT162b2 versus placebo. Using RevMan5.4 software, meta-analysis was conducted to compare the effects of injection of BNT162b2 and placebo on the incidence of adverse reactions in healthy adults over 16 years of age. Main indexes include total incidence of adverse reactions, the incidence of local adverse reactions at the injection site (including red hot accessories), the incidence of systemic adverse reactions, including fever, headache, rash, urticaria, joint pain, muscle pain, gastrointestinal tract reaction, fatigue, cough, etc.), death rate, so as to provide a reference for clinical practice. Information sources: The following electronic databases will be searched from January 2020 to November 2021: PubMed, the Cochrane Library, Web of Science, Embase Electronics. In addition, reference lists of the included studies were manually searched to identify additional relevant studies.

Cell-Free DNA Screening for Sex Chromosome Abnormalities and Pregnancy Outcomes, 2018–2020: A Retrospective Analysis

To evaluate the efficacy of non-invasive prenatal screening (NIPT) for detecting fetal sex chromosome abnormalities, a total of 639 women carrying sex chromosome abnormalities were selected from 222,107 pregnant women who participated in free NIPT from April 2018 to December 2020. The clinical data, prenatal diagnosis results, and follow-up pregnancy outcomes of participants were collected. The positive predictive value (PPV) was used to analyze the performance of NIPT. Around 235 cases were confirmed with sex chromosome abnormalities, including 229 cases with sex chromosome aneuploidy (45, X (n = 37), 47, XXX (n = 37), 47, XXY (n = 110), 47, XYY (n = 42)) and 6 cases with structural abnormalities. The total incidence rate was 0.11% (235/222,107). The PPV of NIPT was 45.37% (235/518). NIPT accuracy for detecting sex chromosome polysomes was higher than that for sex chromosome monomers. The termination of pregnancy rate for fetal diagnosis of 45, X, and 47, XXY was higher than that of 47, XXX, and 47, XYY. The detection rate of fetal sex chromosome abnormalities was higher in 2018–2020 than in 2010–2012 (χ2 = 69.708, P < 2.2 × 10−16), indicating that NIPT is greatly efficient to detect fetal sex chromosome abnormalities.

96小時重置周邊靜脈導管之效應：資料庫分析

<p>目的：透過異常通報資料庫分析，探討96小時對照72小時重置周邊靜脈導管，對於靜脈炎發生率之影響。</p> <p>方法：方便取樣臺灣南部某醫學中心之異常通報資料庫，分析2011年9月1日至2014年8月31日之72小時重置組，與2014年9月1日至2017年8月31日之96小時重置組，2個時期之住院個案的靜脈炎發生率。</p> <p>結果：96小時對照72小時重置周邊靜脈導管，並未增加靜脈炎發生率。靜脈炎總發生率（勝算比[odds ratio,OR] = 0.70, p=.0290）與細菌性靜脈炎發生率(OR= 0.11, p=.0097)顯著減少，化學性與機械性靜脈炎發生率則無顯著差異。</p> <p>結論：本土性資料庫分析結果為在臺灣熱帶海島型潮濕氣候，三班評估無靜脈炎症狀下，96小時重置周邊靜脈導管並不會顯著增加靜脈炎風險，建議醫療機構可據此調整臨床作業規範，落實實證知識轉譯。</p> <p>&nbsp;</p><p>&quot;Purpose: To compare the effect of replacement of peripheral venous catheters at 96-hour intervals on the incidence of phlebitis with that at 72-hour intervals through analysis of an incident-reporting database.</p> <p>Methods: Convenience sampling of records from the incident-reporting database of a medical center in southern Taiwan was used to analyze the incidence of phlebitis among hospitalized patients with replacement of peripheral venous catheters at 72-hour intervals (from September 1, 2011, to August 31, 2014) or 96-hour intervals (from September 1, 2014, to August 31, 2017).</p> <p>Result: The analysis revealed that replacing peripheral venous catheters every 96 hours rather than every 72 hours did not increase the incidence of phlebitis. The total incidence of phlebitis (odds ratio [OR]=0.70, p=.0290) and the incidence of bacterial phlebitis (OR=0.11, p=.0097) decreased significantly, and no significant differences in the incidence rates of chemical or mechanical phlebitis were identified.</p> <p>Conclusion: According to the analysis results of a local database, under the humid tropical insular climate of Taiwan, replacement of peripheral venous catheters at 96-hour intervals did not significantly increase the risk of phlebitis in patients who exhibited no symptoms of phlebitis as assessed in three shifts. Medical institutions can adjust their clinical operation standards and implement knowledge translation accordingly.</p> <p>&nbsp;</p>

Lifetime Carcinogenic Risk Proportions from Inhalation Exposures in Industrial and Non-Industrial Regions

The aim of this work was to estimate the share of selected significant risk factors for respiratory cancer in the overall incidence of this disease and their comparison in two environmentally different burdened regions. A combination of a longitudinal cross-sectional population study with a US EPA health risk assessment methodology was used. The result of this procedure is the expression of lifelong carcinogenic risks and their contribution in the overall incidence of the disease. Compared to exposures to benzo[a]pyrene in the air and fibrogenic dust in the working air, several orders of magnitude higher share of the total incidence of respiratory cancer was found in radon exposures, for women 60% in the industrial area, respectively 100% in the non-industrial area, for men 24%, respectively 15%. The share of risks in workers exposed to fibrogenic dust was found to be 0.35% in the industrial area. For benzo[a]pyrene, the share of risks was below 1% and the share of other risk factors was in the monitored areas was up to 85%. The most significant share in the development of respiratory cancer in both monitored areas is represented by radon for women and other risk factors for men.

Correlation between Parturients’ Uterine Artery Blood Flow Spectra in the First and Second Trimesters of Pregnancy and Fetal Growth Restriction

Objective. To explore the correlation between parturients’ uterine artery blood flow spectra in the first and second trimesters of pregnancy and fetal growth restriction (FGR). Methods. The data of parturients treated in our hospital from February 2018 to February 2020 were retrospectively analyzed, 50 parturients with FGR were selected as the FGR group, and other 50 healthy cases were selected as the control group. In the first trimester (11-12 weeks of gestation) and the second trimester of pregnancy (13–24 weeks of gestation), the parturients of the two groups accepted the color Doppler ultrasonography (CDS), their hemodynamics indicators of uterine artery were recorded, and the correlation between their uterine artery blood flow spectra in the two periods and FGR was analyzed with the Receiver Operating Characteristic (ROC) curve. Results. No statistical differences in the parturients’ general information including age, gestational weeks, gravidity, and parity between the two groups were observed ( P > 0.05); the newborn’s body weight, Apgar scores, number of preterm infants, and the number of infants transferring to the neonatal intensive care unit (NICU) were significantly different between the two groups ( P < 0.05); in the first and second trimesters of pregnancy, the uterine artery pulsatility index (UtA-PI), uterine artery resistance index (UtA-RI), maximal systolic flow velocity, and systolic/diastolic (UtA-S/D) ratio were significantly higher in the FGR group than in the control group ( P < 0.05), and the time-averaged maximal velocity (TAMX) was significantly lower in the FGR group than in the control group ( P < 0.001); in early pregnancy, the incidence of early diastolic notch at bilateral uterine arteries between the two groups was not significantly different ( P > 0.05), and the unilateral and total incidence in the first trimester as well as the unilateral, bilateral, and total incidence in the second trimester were significantly higher in the FGR group than in the control group ( P < 0.05); in the first trimester, the sensitivity of detecting FGR with a uterine artery blood flow spectrum was 0.820, AUC (95% CI) = 0.840 (0.757–0.923), and in the second trimester, it was 0.860, AUC (95% CI) = 0.900 (0.832–0.968). Conclusion. There is a correlation between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR, and the sensitivity of spectrum in the first trimester is higher than that in the second trimester, presenting a better clinical application value.

Estimating real snakebite incidence in Colombia by using mathematical modelling and statistical inference.

Snakebite envenoming is a Neglected Tropical Disease affecting mainly deprived populations. Its burden is normally underestimated because patients prefer to seek for traditional medicine. Thus, applying strategies to optimize disease' management and treatment delivery is difficult. We propose a framework to estimate snakebite incidence at a fine political scale based on available data, testing it in Colombia. First, we produced snakebite fine-scale risk maps based on the most medically important venomous snake species (Bothrops asper and B. atrox). We validated them with reported data in the country. Then, we proposed a generalized mixed effect model that estimates total incidence based on produced risk maps, poverty indexes, and an accessibility score that reflects the struggle to reach a medical center. Finally, we calibrated our model with national snakebite reported data from 2010 to 2019 using a Markov chain Monte Carlo (MCMC) algorithm and estimated underreporting based on the total incidence estimation. Our results suggest that 10.3% of total snakebite cases are not reported in Colombia and do not seek medical attention. The Orinoco and Amazonian regions (east of Colombia) share a high snakebite risk with a high underreporting. Our work highlights the importance of multidisciplinary approaches to face snakebite.

EPIDEMIOLOGICAL ASSESSMENT OF DYMAMICS OF THE PREVALENCE AND INCIDENCE OF THE THYROID GLAND DISEASES IN UKRAINE AND CHERNIVTSI REGION

Objective – to assess the dynamics of the prevalence and incidence of the thyroid diseaseamong the adult population of Ukraine and Chernivtsi region during 2015-2020.Material and methods. A comparative analysis of official accounting and reportingstatistics of the Ministry of Health of Ukraine and the main indicators of the endocrinologyservice of Chernivtsi region on the prevalence and incidence of adult pathology of thethyroid gland over the past 5 years.Results. In Ukraine, the number of pathologies of the thyroid gland has increased,accounting for 48% of the total incidence of endocrine diseases. The most commonpathology is diffuse and nodular goitres. Their level in the western region, includingChernivtsi region, is higher than the national average. In Ukraine the incidence ofhypothyroidism has increased 20.3% for 5 years. Thyrotoxicosis increased 9.1%, andthe prevalence of thyroiditis increased 16.8%. The increase in the Chernivtsi region wasslightly lower. The high frequency of thyroid pathologies depends on the imbalance oftrace elements and vitamins in the diet against a background of iodine deficiency in thediet, environmental degradation and insufficient preventive measures.Conclusions. The analysis shows that in the western regions of Ukraine it is necessaryto apply a differentiated approach to the diagnosis, treatment and prevention of patientswith various thyroid diseases.

Analysis of the Effect of Cluster Nursing in Postoperative Hypertensive Cerebral Hemorrhage

Hypertensive intracerebral hemorrhage is a common condition in clinic. Due to the improvement of minimally invasive technology, its therapeutic effect is good, but there are still postoperative complications. The corresponding routine nursing intervention is not effective in the rehabilitation of postoperative patients with hypertensive intracerebral hemorrhage. In this paper, cluster nursing was applied to the treatment of postoperative patients with hypertensive intracerebral hemorrhage. For this purpose, a retrospective study or experiment was conducted on 150 patients with hypertensive intracerebral hemorrhage in the hospital specifically from January 2019 to December 2020. According to the nursing strategy, patients were divided into experimental (n = 75) and control groups (n = 75), respectively. The control group adopted routine nursing mode, whereas the experimental group adopted cluster nursing mode. The treatment compliance of patients in the experimental group was 86.67%, while that in the control group was 73.33% ( P < 0.05). The total incidence of postoperative complications in the experimental group was 3.2%, which was lower than 25% in the control group ( P < 0.05). The motor function score of the experimental group was better than that of the control group ( P < 0.05). The application of cluster nursing in postoperative patients with hypertensive intracerebral hemorrhage is feasible, and its nursing effect is significant, which can not only reduce the incidence of postoperative complications but also improve patients’ compliance and quality of life. It has good application value.