Chin Med Research Articles

Hepatobiliary surgery in Taiwan: The past, present, and future. Part I; biliary surgery

Abstract In Taiwan, most surgical services were mainly provided by Japanese or Western surgeons before World War II. Tsuchiya Kunita first reported surgical treatment of gallstone diseases in 1915 in Taiwan. After World War II, experienced Japanese surgeons returned to Japan, and well-trained surgeons moved to Taiwan from different hospitals in Mainland China after 1949. In 1954, Liao had reported surgical gallstone diseases treated by cholecytostomy, cholecystectomy, and cholecystogastrostomy or cholecystoduodenostomy from National Taiwan University Hospital (Formos J Surg. 1954;53:833–4). By using of operative cholangiography, diagnosis and removal of intrahepatic stones could be done through choledochostomy reported first by Lee HC from National Defense Medical Center in 1966 and 1968 (Chin Med J ROC. 1966;13:301–8; Chin Med J ROC. 1968;15:124–34). Wei from the National Taiwan University Hospital reported the first left hepatectomy for treating hepatolithiasis on one patient among his series in 1971 (Formos J Surg. 1971;4:178–96). Treatments of hepatolithiasis were well analyzed by Wen and Lee from Triservice General Hospital and Veterans General Hospital in 1972 (Ann Surg. 1972;175:166–77). Hwang was the first to use choledochofiberscope for removing retained stones since 1974 reported from Show Chwan Memorial Hospital in 1978 (Am J Surg. 1978;139:860–4). The first laparoscopic cholecystectomy was performed by Huang from Taipei Cathay General Hospital in 1990 in Taiwan (J Formos Med Assoc. 1991;90:893–9). Nowadays, Taiwan hepatobiliary surgeons were extensively using either laparoscopic or robotic surgery for treatment of hepatobiliary diseases. In conclusion, we should never forget the great contributions from many clinics in rural villages hosted by Christian or Catholicism organizations in Taiwan hundred years ago. We should express our appreciations to the history of the evolutions of biliary surgical skills. In Taiwan, a great surgeon today is always standing on the shoulders of our ancient giants, our surgical teachers.

DP04 Role of multidisciplinary team meetings in management of inflammatory skin conditions

Abstract The multidisciplinary team (MDT) model has been previously demonstrated to improve early diagnosis and outcomes for psoriatic arthritis [Zheng YX, Zheng M. A multidisciplinary team for the diagnosis and management of psoriatic arthritis. Chin Med J (Engl) 2021; 134:1387–9; Luelomo J, Gratacós J, Martínez-Losa MM et al. A report of 4 years of experience of a multidisciplinary unit of psoriasis and psoriatic arthritis. Reumatol Clin 2014; 10:141–6]. However, there is little evidence for a similar role in inflammatory skin disease (ISD). A monthly psoriasis MDT has been established in our tertiary referral dermatology centre. We analysed referrals from February 2021 to February 2022. A total of 37 patient cases were discussed, 29 from within the geographical region of the centre and eight from outside the region. Reasons for referral were the presence of comorbidities; in the majority of cases, this was the presence of an internal malignancy (n = 15). Additional comorbidities were organ transplantation (n = 2), inflammatory bowel disease (n = 2), coexisting inflammatory arthritis (n = 4) and history of severe infection (n = 2). The secondary reason for referral was a history of multiple treatment failures (n = 8) and/or adverse effects of current biologics (n = 2). Where outcome data for regional patients could be assessed, the majority (n = 16) subsequently demonstrated objective improvement in their skin condition, with a mean reduction in Psoriasis Area and Severity Index score of 79.0% (n = 16) and a concurrent mean improvement of 59.6% in Dermatology Quality of Life Index (n = 11). Three patients died (unrelated to psoriasis/treatment). In summary, the presence of comorbidities and prior treatment failures are the primary reasons for referral to a tertiary referral service psoriasis MDT. Multidisciplinary team discussion results in objective improvements in patient care at early follow-up assessments. Further data on MDT outcomes for ISD are required.

Epistemological Challenges of Artificial Intelligence Clinical Decision Support Tools in Otolaryngology: The Black Box Problem.

Epistemological Challenges of Artificial Intelligence Clinical Decision Support Tools in Otolaryngology: The Black Box Problem.

Recurrent Giant Myofibroblastic Sarcoma of Neck in a Teenager: Overcoming Treatment Challenges

Sarcomas are rare tumors arising from a variety of mesenchymal tissues which are even rarer in head and neck region amounting 1% only of the 5% of sarcomas. About 80% of head and neck sarcomas originate in soft tissue while the remaining 20% arise from bone (Cormier and Pollock in J Clin 54:94−109, 2004). One among the commonly presenting variants of sarcomas in head and neck that our patient was diagnosed with is Low grade myofibroblastic sarcoma (LGMS). These even though uncommon have a predilection for head and neck region particularly the tongue (Mentzel et al. in Am J Surg Pathol 22:1228−38, 1998; Cai et al. in Virchows Arch 463:827−36, 2013; Meng et al. in Chin Med J 120:363–9, 2007; Demarosi et al. in Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 108:248–54, 2009). LGMS was reclassified as a distinct entity by the WHO classification of soft tissue tumors in 2002 (Qiu et al. in Oncol Lett 9:619−25, 2015). Oncological resection is the mainstay of treatment. In case of bulky tumor, resection and reconstruction would be challenging. We report a recurrent LGMS of 15-year-old girl who presented with a ginormous soft tissue swelling in her left neck region which made her day-to-day activities strenuous and made her non ambulatory and the line of treatment executed in order to get her back on feet, healthy & free of the debilitating tumor.

The rise of immuno-oncology in China: a challenge to western dominance?

China has had one of the most rapid global cancer transitions, 1 Cao W Chen HD Yu YW Li N Chen WQ Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). 2021; 134: 783-791 Crossref PubMed Scopus (724) Google Scholar closely resembling that of other high Human Development Index countries. China has a population of more than 1·4 billion people, and is home to the largest global population of older people (aged ≥60 years), equating to approximately 254 million people as of 2019, and is predicted to increase further to 402 million people (to comprise approximately 28% of the national population) by 2040. 2 The LancetPopulation ageing in China: crisis or opportunity?. Lancet. 2022; 4001821 Summary Full Text Full Text PDF Scopus (1) Google Scholar Cancer care and research have been recognised as one of five key areas of focus in the Chinese Government's Healthy China Action Plan 2019–2030. 3 Department of PlanningDevelopment and Information TechnologyHealthy China Action (2019–2030) Chinese Government. http://www.nhc.gov.cn/guihuaxxs/s3585u/201907/e9275fb95d5b4295be8308415d4cd1b2.shtmlDate: July 15, 2019 Date accessed: January 28, 2023 Google Scholar New cancer drug development, with an emphasis on Chinese national research and development, has been consistently supported in Chinese Government planning, being integrated into the 11th, 12th, and 13th 5-year plans for major new drug innovation. 4 Ministry of Science TechnologyAnnouncement of the State Ministry of Science and Technology on the application of the first batch of Chinese National Major Project for New Drug Innovation for the 11th five-year plan. http://www.most.gov.cn/tztg/200809/t20080901_63712.htmlDate: Sept 1, 2008 Date accessed: January 26, 2023 Google Scholar To foster wider global drug development collaboration, the Drug Supervising and Regulatory Department of China has joined the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use to ensure that international standards for ethical integrity and scientific quality for conducting trials are implemented nationally. 5 Yang F Heng J Li K Wang J The new Good Clinical Practice-2020 in China: views from ethical perspective. Lancet Reg Health West Pac. 2021; 8100117 Google Scholar Furthermore, regulatory innovation at the National Medical Products Administration has resulted in the implementation of new faster regulatory approval pathways, which emphasise approval based on clinical value. 6 Zhang Y Naci H Wagner AK et al. Overall survival benefits of cancer drugs approved in China from 2005 to 2020. JAMA Netw Open. 2022; 5e2225973 Crossref Scopus (7) Google Scholar , 7 Luo X Du X Li Z Qian F Yang Y Assessment of the delay in novel anticancer drugs between China and the United States: a comparative study of drugs approved between 2010 and 2021. Clin Pharmacol Ther. 2023; 113: 170-181 Crossref PubMed Scopus (3) Google Scholar There is also little doubt that biopharmaceuticals will become a core global industrial domain within China's Belt and Road Initiative.

Not all right lower abdominal pain is appendicitis

British Journal of Hospital MedicineEarly view Images in MedicineNot all right lower abdominal pain is appendicitisYoen Young Chuah, Mindy Ming-Huey Guo, Yeong Yeh LeeYoen Young ChuahCorrespondence to: Yoen Young Chuah; E-mail Address: [email protected]Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Ping Tung City, TaiwanDepartment of Nursing, Meiho University, Pingtung, TaiwanSearch for more papers by this author, Mindy Ming-Huey GuoDepartment of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanSearch for more papers by this author, Yeong Yeh LeeDepartment of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, MalaysiaSearch for more papers by this authorYoen Young Chuah; Mindy Ming-Huey Guo; Yeong Yeh LeePublished Online:15 Mar 2023https://doi.org/10.12968/hmed.2022.0237AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Chang KM. New histologic findings in idiopathic mesenteric phlebosclerosis: clues to its pathogenesis and etiology–probably ingested toxic agent-related. J Chin Med Assoc. 2007;70(6):227–235. https://doi.org/10.1016/S1726-4901(09)70364-8 Crossref, Medline, Google ScholarHiramatsu K, Sakata H, Horita Y et al.. Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine. Aliment Pharmacol Ther. 2012;36(6):575–586. https://doi.org/10.1111/j.1365-2036.2012.05221.x Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 15 March 2023 Information© MA Healthcare LimitedPDF download

PULMONARY CAPILLARY HEMANGIOMATOSIS: A CONUNDRUM FOR EXPERTS

PULMONARY CAPILLARY HEMANGIOMATOSIS: A CONUNDRUM FOR EXPERTS

Global epidemiology and prevention of colorectal cancer

Characterisation of the global variation in disease burden and temporal trends can provide important clues about disease aetiology and inform prevention strategies. Although previous studies have reported geographical and temporal trends in the incidence of and mortality due to colorectal cancer based on data from the GLOBOCAN database, 1 Sung H Ferlay J Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71: 209-249 Crossref PubMed Scopus (13427) Google Scholar , 2 Arnold M Sierra MS Laversanne M Soerjomataram I Jemal A Bray F Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017; 66: 683-691 Crossref PubMed Scopus (2385) Google Scholar , 3 Lu B Li N Luo CY et al. Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000–2019. Chin Med J. 2021; 134: 1941-1951 Crossref PubMed Scopus (7) Google Scholar , 4 Arnold M Abnet CC Neale RE et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020; 159: 335-349 Summary Full Text Full Text PDF PubMed Scopus (305) Google Scholar data on disability-adjusted life years (DALYs) due to colorectal cancer and the contributing risk factors remain sparse. Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. Full-Text PDF Open Access

Pathogenesis of anti-melanoma differentiation-associated gene-5 (MDA5) dermatomyositis.

Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China. Correspondence to: Zhichun Liu, Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, Jiangsu 215000, China E-Mail: [email protected] How to cite this article: Weng C, Liu Z. Pathogenesis of anti-melanoma differentiation-associated gene-5 (MDA5) dermatomyositis. Chin Med J 2022;00:00–00. doi: 10.1097/CM9.0000000000002049 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.cmj.org). Received July 1, 2021 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

The possible role of ursolic acid in Covid-19: A real game changer.

Ursolic acid (UA) is a pentacyclic terpenoid is usually found in the fruit peels and stem bark as secondary metabolites. UA has antiviral, antibacterial, and antiparasitic properties. UA has a wide spectrum of pharmacological activities against different infections. Because of the greatest antiviral and anti-inflammatory properties of UA, so it could be a plausible therapeutic herbal medicine in Covid-19 treatment. Covid-19 is a recent worldwide virulent disease pandemic due to severe acute respiratory coronavirus disease 2 (SARS-CoV-2). The pathogenesis of SARS-CoV-2 infection is related to the direct cytopathic effect and exaggerated immune response by which acute lung injury (ALI) and/or acute respiratory distress syndrome might be developed in critical cases. UA may inhibit main protease of SARS-CoV-2, and inhibits the interface flanked by SARS-CoV-2 viral proteins and its entry point commonly recognized as angiotensin converting enzyme 2 (ACE2). In addition, UA attenuates SARS-CoV-2-induced inflammatory reactions and oxidative stress.Therefore, UA could avert SARS-CoV-2 infection from causing ALI. This opinion proposed that UA might be a potential candidate therapy against Covid-19 and can mitigate post-Covid-19 complications such as lung fibrosis. In this regards, forthcoming studies are reasonable to substantiate the therapeutic role of UA in Covid-19. However, taken into account that Covid-19 is yet to be investigating for further evaluations, therefore, clinical trials are recommended regarding use and dose of UA in Covid-19 treatment, as well as secondary effects.

A CORRELATION OF NEUROCYSTICERCOSIS AND IGG4 ANTIBODIES

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: In endemic regions, 30% of patients presenting with epilepsy, have evidence of neurocysticercosis. In the US, between the years of 2003 and 2012, there were more than 18,000 hospitalizations for neurocysticercosis. A study done in 2002 showed that IgG4 was found in the sera of patients with cerebral cysticercosis 97.8% of the time. Reliance on immunological assays holds importance due to the lower costs in comparison to imaging studies in impoverished areas. This case presentation follows a patient with a ring-enhancing brain lesion, positive cysticercosis antibodies, and positive IgG4 cells on tissue biopsy. CASE PRESENTATION: A 56-year-old male with a past medical history of hypertension, recent head injury and no other risk factors, presented for evaluation of syncope. Before the syncopal episode, the patient was seen by the primary physician for sustained injury to his head with complaints of recurrent fevers, headache, and blurred vision. The patient was prescribed steroids and antibiotics but did not feel any improvement and ended having a syncopal episode with a brief loss of consciousness. Magnetic resonance imaging of the brain with contrast showed a 17mm right mid corona radiata/mid-lateral ventricle peripherally enhancing mass with surrounding white matter edema and centralized restricted diffusion. Patient was admitted to the intensive care unit and treated with antibiotics, steroids, and antiepileptics. Stereotactic brain biopsy showed brain parenchyma with mildly increased cellularity consisting primarily of glial cells suggestive of reactive tissue. All labs and immunological studies were negative except for positive Cysticercosis IgG Antibody. Computed tomography of the abdomen and pelvis was positive for a 3 cm low-density lesion in the right lobe of the liver for which biopsy showed rare CMV inclusions in infected cells on a background of storiform fibrosis and lymphoplasmacytic inflammation with numerous IgG4 positive cells. The patient was started on albendazole and over the course of a few days, symptoms significantly improved. DISCUSSION: Brain biopsy showed only reactive tissue, hence to ensure no other primary lesion is present, further imaging tests were ordered which led to the revelation of the liver lesion and the biopsy was pathognomonic for IGG4 related disease, however, due to a lack of other necessary diagnostic criteria (serum IgG4 above 135 and histopathology showing IGG4 positive cells greater than 40%), the conclusion was not reached. However, due to the ring-enhancing lesion and positive cysticercosis IgG antibody, neurocysticercosis was higher on the differential as IgG4 is the most commonly found antibody in serum or CSF. CONCLUSIONS: Our findings of a correlation between neurocysticercosis and IgG4, strengthen the promise of a better immunodiagnostic tool thereby fighting the issues of accessibility and cost-effectiveness for endemic areas. REFERENCE #1: O'Neal SE, Flecker RH. Hospitalization frequency and charges for neurocysticercosis, United States, 2003-2012. Emerg Infect Dis. 2015 Jun;21(6):969–76. REFERENCE #2: Huang B, Li G, Jia F, Liu F, Ge L, Li W, et al. Determination of specific IgG4 for diagnosis and therapeutic evaluation of cerebral cysticercosis. Chin Med J (Engl). 2002 Apr;115(4):580–3. REFERENCE #3: Legatowicz-Koprowska M. IgG4-related disease: why is it so important? Cent-Eur J Immunol. 2018;43(2):204–8. DISCLOSURES: No relevant relationships by Rahul Dadhwal, source=Web Response no disclosure on file for Lauren Howard; No relevant relationships by Alamgir Khan, source=Web Response No relevant relationships by Katrina Rathjen, source=Web Response No relevant relationships by Salim Surani, source=Web Response

A CASE OF RECURRENT PNEUMOTHORACES IN A NEWBORN

TOPIC: Pediatrics TYPE: Fellow Case Reports INTRODUCTION: Recurrent pneumothroaces (PTX) is an uncommon presentation in the newborn period, often associated with prematurity or ventilator use. This is a case of rapidly progressive cystic disease in the setting of an absent right pulmonary artery. CASE PRESENTATION: Patient is a 18do female, ex-37 weeks gestation, with negative prenatal history. Noted at birth to have meconium aspiration at birth, cyanosis and non-invasive positive pressure ventilation (PPV) at 9 hours of life. CXR showed R PTX, that was resolved with chest tubes and discharged on day of life (DOL) 11. Presented on DOL) 17 with respiratory distress and was found to have a PTX. Chest CT showed R PTX with cystic foci in all three lobes thought to be related to pulmonary interstitial emphysema (PIE). Cardiothoracic surgery felt patient was too young for surgery and recommended more conservative management. Presented on DOL 27 with recurrrent PTX and then again at 3 months of life. Chest CT at this time showed a absent R pulmonary artery not previously recognized. ECHO confirmed absence of R PA. Patient underwent R pneumonectomy with mediastinal tent placement. Pathology showed pneumatoceles in lower lobes, focal areas of dysplastic lung development, absent large hilar pulmonary arteries, lymphangiectasis and pleural fibrosis. Cytology showed few multinucleated giant cells and fibroblastic proliferation along pneumatocele wall. DISCUSSION: Air leak syndromes such as PTX and PIE are more common in neonates with prematurity, need for PPV, meconium aspiration, and pulmonary hypoplasia. The presence of meconium aspiration and need for PPV likely contributed to the initial pulmonary insult that led to her clinical picture. Persistent PIE can associated with multiple large pseudocysts. Presence of multinucleated giant cells with fibroblast proliferation in cytology further supports presence of persistent PIE. In addition the unilateral absence of the R pulmonary artery (UAPA) can contribute to hypoperfusion and hypoplasia. This can subsequently lead to the cystic development especially when there are multiple other insults to the lung as seen in this patient. Post-pneumonectomy complications include concern for development of pulmonary hypertension as well as complication related to the post-pneumonectomy space, such as mediastinal shift causing compression of the airways. CONCLUSIONS: Recurrent PTX can be due to a wide variety of etiologies based on patient's age and presentation. This case highlights recurrent PTX in a neonate in the setting of cystic lung disease that is likely from persistent PIE with further contribution from a unilaterally absent pulmonary artery. REFERENCE #1: Jeng, M.J., Lee, Y.S., Tsao, P.C. & Soong, W.J. Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc 75, 551-559 (2012). REFERENCE #2: Agrons, G.A., Courtney, S.E., Stocker, J.T. & Markowitz, R.I. From the archives of the AFIP: Lung disease in premature neonates: radiologic-pathologic correlation. Radiographics 25, 1047-1073 (2005). REFERENCE #3: Kruzliak, P., Syamasundar, R.P., Novak, M., Pechanova, O. & Kovacova, G. Unilateral absence of pulmonary artery: pathophysiology, symptoms, diagnosis and current treatment. Arch Cardiovasc Dis 106, 448-454 (2013). DISCLOSURES: No relevant relationships by Ashish George, source=Web Response no disclosure on file for Robin Ortenberg; No relevant relationships by Swaroop Pinto, source=Web Response

Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer.

Endoscopic oncoplastic breast surgery represents a minimal invasive approach with the aim of both safe excision of cancer and preserving the breast shape. It has less noticeable scar, excellent cosmetic outcomes, high patient satisfaction rate. Recently, relative long-term follow-up results have been reported to be very safe (Soybir and Fukuma, J Breast Health 11:52-58, 2015; Fan et al., Chin Med J 122:2945-2950, 2009; Jiang, Zhonghua Wai Ke Za Zhi 45:439-441, 2007).Operative techniques for both endoscopic breast-conserving surgery and endoscopic nipple/areola/skin-sparing mastectomy have been described in detail. Two different working planes in which one of them is subcutaneous and the other one is sub-mammary planes are being used during the surgery. Surgical technique needs some instruments such as endoscopic retractor, light guided specific mammary retractor, wound protector, and energy device such as bipolar scissor, Harmonic Scalpel, LigaSure, Thunderbeat. Endoscopic breast retractors provide magnified visualization and extensive posterior dissection facility. Tunneling method and the hydro-dissection simplify the technique in the subcutaneous field (Soybir and Fukuma, J Breast Health 11:52-58, 2015; Fan et al., Chin Med J 122:2945-2950, 2009). Oncoplastic reconstruction techniques are also applied after the tumor resection by endoscopic method. The complication rate of endoscopic breast surgery is similar with the rate of open breast surgery. Quite successful local recurrence, distant metastasis, and overall survival rates have been declared. However, it looks reasonable to wait for the results with longer follow-up before having a judgement about oncologic efficiency and safety of the endoscopic breast cancer surgery (Tamaki et al., Nihon Geka Gakkai Zasshi 103(11):835-838, 2002; Leff et al., Breast Cancer Res Treat 125(3):607-625, 2011; Fukuma, Nihon Geka Gakkai Zasshi 116(5):316-319, 2015).Recently some surgeons reported about robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant procedure. Nevertheless, experience with application of a robotic surgery platform in the management of breast cancer is limited. From the preliminary experiences, R-NSM and IBR with Gel implant is a safe procedure, with good cosmetic results, and could be a promising new technique for breast cancer patients indicated for mastectomy (Lai et al., Ann Surg Oncol 26(1):42-52, 2019).

Treatment of Stage 3 COVID-19 With Transcutaneous Auricular Vagus Nerve Stimulation Drastically Reduces Interleukin-6 Blood Levels: A Report on Two Cases

Treatment of Stage 3 COVID-19 With Transcutaneous Auricular Vagus Nerve Stimulation Drastically Reduces Interleukin-6 Blood Levels: A Report on Two Cases

Navigating the COVID-19 pandemic: Initial impacts and responses of the Organ Procurement and Transplantation Network in the United States.

COVID‐19 has been sweeping the globe, hitting the United States particularly hard with a state of emergency declared on March 13, 2020. Transplant hospitals have taken various precautions to protect patients from potential exposure. OPTN donor, candidate, and transplant data were analyzed from January 5, 2020 to September 5, 2020. The number of new waiting list registrations decreased, with the Northeast seeing over a 50% decrease from the week of 3/8 versus the week of 4/5. The national transplant system saw near cessation of living donor transplantation (−90%) from the week of 3/8 to the week of 4/5. Similarly, deceased donor kidney transplant volume dropped from 367 to 202 (−45%), and other organs saw similar decreases: lung (−70%), heart (−43%), and liver (−37%). Deceased donors recovered dropped from 260 to 163 (−45%) from 3/8 compared to 4/5, including a 67% decrease for lungs recovered. The magnitude of this decrease varied by geographic area, with the largest percent change (−67%) in the Northeast. Despite the pandemic, discard rates across organ has remained stable. Although the COVID‐19 pandemic continues to evolve, OPTN data show recent evidence of stabilization, an indication that an early recovery of the number of living and deceased donors and transplants has ensued.

Effects of Shenqi compound on intestinal microbial metabolites in patients with type 2 diabetes: A protocol for systematic review and meta analysis.

Introduction:According to the data from the 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes [Chin J Diabetes. 2017;20:81–117],[1] in 2013, the incidence of T2DM in China was 10.4%, while nearly 63% of the patients did not receive standard diagnosis. T2DM has become a serious public health problem in China and even in the world. Intestinal flora, as a research hotspot related to T2DM and other diseases in recent years, is a kind of microorganism with a large number in the human intestinal tract, which is considered as one of the important factors affecting the metabolism of the endocrine system and the human internal environment. In fact, many concepts of traditional Chinese medicine (TCM) coincide with modern research results of intestinal flora. In fact, TCM is also widely used to regulate intestinal flora disorders, and plays a very important role in restoring the dysfunctional intestinal flora [Hu et al. Drug Eval. 2013:8–10].[2] T2DM is a chronic systemic progressive disease. Studies [Wang et al. Tianjin Chin Med. 2007;24:507–508][3] have shown that even ideal blood glucose control cannot prevent the failure of islet cells [Wang et al. Tianjin Chin Med. 2007;24:507–508],[3] and how to restore the function and number of islet cells has naturally become the focus and difficulty of our current research. Studies have shown that the changes in the contents of intestinal microflora and their metabolites are closely related to the performance of T2DM such as hyperglycemia, insulin resistance, and restoration of islet function, and play an important role in pathophysiological mechanisms such as chronic inflammation of T2DM [Sun et al. Shi Zhen Chin Med. 2012;23:1434–1436].[4] It has been confirmed that Shenqi compound, a TCM, regulates intestinal flora of T2DM. However, due to the lack of evidence, there is no specific method or suggestion, it is necessary to make a systematic evaluation of Shenqi compound to provide effective evidence for further research.Methods and analysis:Electronic databases included PubMed, Embase, Cochrane Library, Web of Science, Nature, Science Online, WanFang China Biomedical Database, VIP Medical Information, China national Knowledge Infrastructure (CNKI).Main results: Endotoxin, short-chain fatty acid, bile acid, indole.Other results: low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), total serum cholesterol (TC). The data will be extracted independently by 2 researchers, and the risk of bias in the meta-analysis will be systematically evaluated according to the Cochrane handbook. All data analysis will be performed using the Data statistics software Review Manager V.5.3. And occupy V.12.0.Results:The results of this study will systematically evaluate the effectiveness and safety of Shenqi compound on the effects of intestinal flora metabolites in patients with type 2 diabetes.Conclusion:Through the systematic review of this study, the published evidence of the effect of Shenqi compound on intestinal flora metabolites in patients with type 2 diabetes was summarized to further guide its promotion and application.Ethics and communication:This study is a systematic review with findings based on published evidence and does not require erB review or consent. We plan to publish the results in a journal or conference report.Open science framework (OSF) registration number:September 29, 2020. osf.io/gb3m2.(https://osf.io/gb3m2).

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Treatment Options for Coronavirus Disease 2019 in Patients With Reduced or Absent Kidney Function.

Coronavirus disease 2019, the disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was first identified in the Hubei Province of China in late 2019. Currently, the only role for therapy is treatment of the disease, as opposed to postexposure prophylaxis, however multiple clinical trials are currently ongoing for both treatment and prophylaxis. Treating coronavirus disease 2019 relies on two components; the first is inhibition of the viral entrance and replication within the body and the second is inhibition of an exacerbated immune response which can be seen in patients with severe disease. Many drugs have shown in vitro antiviral activity; however, clinical trials have not been as promising. This review summarizes the current data for the most commonly used drugs for coronavirus disease 2019 and will cover the unique factors that may affect the dosing of these medications in patients with CKD. While clinical trials are ongoing, most are in patients with normal kidney function. During a pandemic, when patients with CKD are at higher risk of both infection and death, it is imperative to include patients these patients in the clinical trials.

Use of SARS-CoV-2-infected deceased organ donors: Should we always "just say no?"

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS‐CoV‐2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS‐CoV‐2 through organ transplantation. The isolation of SARS‐CoV‐2 from nonlung clinical specimens, the detection of SARS‐CoV‐2 in autopsy specimens, previous experience with the related coronaviruses SARS‐CoV and MERS‐CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS‐CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS‐CoV‐2 infection.

Consideration of Pannexin 1 channels in COVID-19 pathology and treatment.

Pannexin1 (PANX1) is a ubiquitously expressed, channel-forming protein found in a number of tissues thoughout the body (e.g. lung, vasculature, liver, central nervous system, immune system) that is important in many key physiological and immune responses. PANX1 channels passively flux ATP (predominantly), multiple metabolites, and likely other small anions. PANX1 channels regulate inflammation and host responses to several pathogens, including viruses. While there is currently no evidence suggesting novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and PANX1 directly interact, there is an urgent need for therapeutic strategies, especially those targeting the hyper-inflammation and cytokine storm that occurs in severe cases of COVID-19. Here we argue that PANX1, and drugs known to target PANX1 (including the FDA-approved drug probenecid), should be the focus of further investigation in the context of SARS-CoV-2 infection and its associated pathology in COVID-19 patients.