Clinical Characteristics Of Group Research Articles

Факторы риска развития рецидивов перианальных инфекционных осложнений у пациентов с опухолевыми заболеваниями системы крови: результаты одноцентрового проспективного исследования

Aim. To study risk factors for relapses of perianal infection (PI) in patients with hematological tumors.
 Materials & Methods. This single-center prospective clinical trial (2016–2020) enrolled all oncohematological patients at the National Research Center for Hematology who developed PI at various stages of chemotherapy. To assess the impact of some factors on relapsing perianal infectious complications, the distribution of clinical characteristics in groups of patients with single or multiple PI episodes was analyzed.
 Results. The trial addressed 158 PI episodes in 132 patients; there were 64 men and 68 women, the median age was 40 years (range 18–77 years). PI relapses were identified in 22 (16.67 %) patients, with a higher incidence in acute myeloid leukemia (AML) patients (63.64 %). Recurrent PI episodes were usually registered on program therapy of acute leukemias (73.08 %), more often at consolidation stage (38.46 %) than at other stages of treatment (17.42 %) (hazard ratio [HR] 2.96; 95% confidence interval [95% CI] 1.19–7.35; p < 0.031). With the follow-up of 360 days from the first episode, the probability of PI relapses was 16.2 %, and it was higher in AML patients (24.3 %). In non-remission AML patients having the first PI episode, the probability of PI relapses considerably increased and accounted for 52.6 %. In case of cryptogenic pararectal abscesses, it was 20 %, if solely abscess drainage was performed at the first stage. However, no relapses were registered after the surgical treatment of pararectal fistulas. The risk factors for recurrent PI, as was shown by univariate analysis, were AML diagnosis (HR 2.94; 95% CI 1.14–7.62; p < 0.032) and the lack of remission of hematological tumor by the time of the first PI episode (HR 2.98; 95% CI 1.13–7.90; p < 0.034). By multivariate analysis, the significant risk factor was non-remission AML diagnosis by the time of the first PI episode (HR 6.94; 95% CI 2.93–16.66; p < 0.0001).
 Conclusion. The significant risk factor for PI relapses is non-remission AML diagnosis by the time of the first infectious episode. This category of patients shows the maximal probability of relapsing perianal infectious complications, which is 52.6 %. To prevent PI relapses in patients with cryptogenic pararectal abscesses, abscess drainage should be combined with scheduled surgery of anal fistulas.

Pre-procedure 18F-FDG PET/CT imaging improves the performance of CT-guided transthoracic biopsy

To compare computed tomography (CT)-guided transthoracic lung biopsies (CTLB) with and without pre-procedure 18F-fludeoxyglucose positron emission tomography (18F-FDG PET)/CT images in the diagnosis of pulmonary nodules/masses. This is a case-control study in a single center. The data of patients with a transthoracic lung biopsy guided by CT and pre-procedure 18F-FDG PET/CT (group 2, here called the “PETCTLB” group), including demographics, clinical characteristics, and biopsy-related parameters, were collected. The PET/CT scan was performed within 15 days before the biopsy. The data from patients with CTLB were used as controls (group 1). Biopsies for all patients were performed by the same physician between January 2019 and December 2021. The final diagnosis was based on surgical outcomes, or imaging findings, and the results of at least one 6-month follow-up. The demographics and clinical characteristics of patients, lesions and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two groups. Two-tailed t-tests were used to compare the mean values in the two independent groups, while categorical variables were compared using the Pearson chi-squared test, and P values < 0.05 were considered to be significant. A total of 84 patients were included, and 84 biopsies of 84 lung nodules/masses were analyzed. The demographics and clinical characteristics of group 2 (n = 39; 21 men; mean age, 63.2 ± 9.29 years) and group 1 (n = 45; 30 men; mean age, 61.2 ± 12.3 years) had no significant difference (P = 0.230 and 0.397, respectively). The procedure duration (11.1 ± 3.0 vs. 12.9 ± 3.3 minutes, P = 0.008), the number of samples (2.6 ± 0.5 vs. 3.1 ± 0.4, P < 0.001), diagnostic accuracy (97.4% vs. 82.2%, P = 0.033), and bleeding complication (25.6% vs. 42.2%, P = 0.034) of group 2 and group 1 were statistically different. A biopsy guided by CT plus pre-procedure 18F-FDG PET/CT (PETCTLB) is a safe procedure that can provide a precise diagnosis in the majority of lung nodules/masses. It has better diagnostic performance than CTLB.

Evaluation of risk factors for recurrence of cutaneous adverse reactions due to anti-seizure medications in children: A retrospective study.

Background: Cutaneous adverse reactions (CARs) are one of the most important reasons for anti-seizure medication (ASM) discontinuation in epilepsy. However, such discontinuations can cause an increase in seizures. This study investigates the risk factors for ASM-related rash recurrence in children. Methods: This retrospective case-control study consisted of the patient group with a single rash due to ASMs (group 1), the patient group with rash recurrence (group 2), and the control group. While the demographic and clinical features of group 1 and the control group were compared in terms of a single rash, group 1 and group 2 were compared for rash recurrence. Results: Group 1, group 2, and control group consisted of 112, 33, and 166 patients, respectively. Female gender was a risk factor for a single rash (P < 0.001) but not for recurrence (P = 0.439). Presence of atopic disease [odds ratio (OR): 9.5, 95% confidence interval (CI): 3.8-23.1, P < 0.001], family history of drug allergy (OR: 26.3, 95% CI: 9.6-72.1, P < 0.001), and polytherapy (OR: 23.5, 95% CI: 8.7-62.9, P < 0.001) were risk factors for rash recurrence. Aromatic nature of both the ASMs associated with the first rash (OR: 14.4, 95% CI: 3.2-63.2, P < 0.001) and rash recurrence (OR: 11.3, 95% CI: 4.6-27.5, P < 0.001) were determined as risk factors separately. Conclusion: Careful use of aromatic drugs may prevent recurrence of ASM-related CAR in children, particularly in cases of personal history of allergic disease and family history of drug allergy.

Irisin, adropin, and preptin as biomarkers of energy dysregulation in depressive disorder

Objective Lack of energy, fatigue, debility are often seen in depression and hardly respond to treatment. Finding some biomarkers for these symptoms may be important for diagnosis and treatment. We aimed to investigate the possible relationship between depression and energy-related molecules irisin, adropin and preptin. Methods There were 117 patients with depression and 59 healthy volunteers included in the study. Sociodemographic characteristics and clinical features of groups were evaluated, and depressed patients were divided into subtypes, then irisin, adropin, preptin levels were compared between depressive patients and healthy controls and between subtypes. Depression severity, quality of life, functionality and the relations with irisin, adropin and preptin levels and associations between depression subtypes were evaluated. Results Irisin, adropin, and preptin levels were lower in depression, positively correlated with quality of life, and negatively correlated with depression severity and functional impairment. Depression subtypes showed no difference in irisin, adropin and preptin levels. Conclusions We found decreased serum irisin, adropin and preptin levels in depression. Our results may support investigation of irisin, adropin and preptin as biomarkers for depression but it might be more meaningful to evaluate these biomarkers in a long-term follow-up.

The onset of cerebral infarction may be affected by differences in atmospheric pressure distribution patterns.

Some papers have highlighted a possible causal relationship between the onset of ischemic stroke and weather conditions. This study aimed to elucidate the onset mechanism of cerebral infarction from a meteorological approach. We focused on the atmospheric pressure distribution patterns (APDPs). The subjects are 221 cases diagnosed as cardiogenic cerebral embolism (Group A) and 612 cases diagnosed as atherosclerotic cerebral thrombosis (Group B). We investigated the APDP on the date closest to the date and time of onset of cerebral infarction in each patient on the website and chose the most similar one from the reported 11 APDPs. Groups A and B were compared for clinical characteristics and the appearance rate of each APDP in each group. The clinical characteristics of Groups A and B were consistent with some previously reported clinical characteristics of cerebral embolism and cerebral thrombosis except for smoking. The appearance rate of the other high-pressure type, which cannot be classified as either the anticyclone belt type or the migratory anticyclone type, in Group B was statistically significantly higher than that in Group A, and the appearance rate of the anticyclone belt type in Group A was statistically significantly higher than that in Group B (p < 0.05, Fisher's exact probability method, respectively). Cerebral embolism and cerebral thrombosis exhibited significant differences in APDPs on the day of onset. Dehydration particularly in the other high-pressure type or in the anticyclone belt type should be prevented. Further investigation should focus on the other meteorological factors.

#5990 COMPLEMENT GENES PROFILE OF PATIENTS WITH SEVERE HYPERTENSION AND RENAL THROMBOTIC MICROANGIOPATHY

Abstract Background and Aims Hereditary or acquired complement system dysregulation found to be driving cause of endothelial damage in atypical haemolytic uremic syndrome (aHUS) – ultrarare life-threatening disease, that always manifests with renal thrombotic microangiopathy (TMA), resulting in poor outcome in absence of appropriate treatment. Nevertheless, several studies show high incidence of rare genetic variants of complement system in other TMA’s, including hypertension-induced TMA. Here we report results of complement genes screening in patients (pts) with histologically identified renal TMA and severe hypertension in Russia, at first diagnosed as hypertension-induced TMA. Method A total of 28 Caucasian pts diagnosed with renal TMA (confirmed by kidney biopsy in all cases) and severe hypertension enrolled in the study. The main characteristic of the clinical picture was the absence of microangiopathic hemolysis and thrombocytopenia in prevailing of the pts, thus most of the primary and secondary causes of TMA clinically excluded. Examination of DNA samples was performed in all pts using next generation sequencing (NGS) technology. For statistical analysis continuous variables were presented as Mean (±Standart deviation) or Median (interquartile range) as appropriate. Results Baseline demographic and clinical characteristics of group are listed in Table 1. 13 pts (46%) had malignant form of hypertension (MHT) confirmed by eye examination. Mean systolic arterial pressure (SAP) observed at the time of presentation was 210±29 mmHg, mean diastolic arterial pressure (DAP) was 122±19 mmHg. Kidney morphology revealed chronic TMA lesions in 12 pts (43%), acute and chronic alterations simultaneously detected in 13 pts (46%). Predominantly acute lesions with glomerular and extraglomerular thrombi found in 3 (11%) pts only. Complement genes abnormalities revealed in 7 (25%) out of 28 pts. Complement factor I (CFI) rare variants were found in 2 pts (CFI c. 772&amp;lt;A, CFI c.1217G&amp;gt;A), one of this pts also had additional variant in complement factor H related protein 4 (CFHR4 c.766G&amp;gt;A). Complement factor C3 rare variant was observed in 1 pt (C3 c.2203C&amp;gt;T), membrane cofactor protein (MCP or CD46) rare variant in 1 pt (CD46 c. 198A&amp;gt;T), complement factor H related protein 5 (CFHR5) variant detected in 1 pt (CFHR5 c.136C&amp;gt;T), homozygous deletion of CFHR1 and CFHR3 detected in 1 pt and heterozygous deletion of the same complement factor H related protein genes found in another pt. Conclusion A quarter of pts with TMA and severe hypertension may have genetic defects in the complement system. These results confirmed that complement-mediated HUS may be misdiagnosed as hypertension-induced TMA. Lack of convincing hematological signs of TMA is common in this group, making aHUS diagnosis more sophisticated.

The Effect of Training About Sleep Hygiene on HbA1c Levels of Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial

Objective: In this study, we aimed to reveal whether training on sleep hygiene have an effect on blood glucose regulation of type 2 diabetes patients. Materials and methods: Those with even protocol numbers were included in the case group and those with odd numbers were included in the control group. Pittsburgh sleep quality index was applied face-to-face to all patients included in the study and at the first admission sleep hygiene training was given to the case group. HbA1c values were noted separately as first and second visit for both groups. Those with known sleep disorders and language or psychiatric problems that would prevent them from answering the questionnaire were excluded from the study. Differences between demographic and clinical features of groups were evaluated using chi-square and Student’s t -tests. Comparisons of the case and control groups before and after sleep hygiene training were evaluated using ANCOVA test adjusted for BMI and DM duration. Results: A total of 347 Type 2 diabetes patients included in this randomized controlled trial (113 case 234 control). Significant difference was observed in the HbA1c values measured before and after the training of the case group. The second mean HbA1c (8.13 ± 2.03 mmol/L) of the control group was significantly higher than the second mean HbA1c (7.51 ± 1.42 mmol/L) values of the case group (p = 0.004). Conclusions: Our study revealed that in addition to classical diabetes treatment, sleep hygiene training also has a positive effect on blood glucose regulation of patients.

A novel refined classification system for type 2 diabetes in adults: A Chinese retrospective cohort study.

We propose a simple type 2 diabetes mellitus (T2DM) classification method based on fasting C-peptide (FCP) levels and examined its feasibility and validity. Adult T2DM patients first diagnosed in our tertiary care centre from January 2009 to January 2020 were included. Patients were followed until January 2021; their clinical characteristics, chronic complications, treatment regimen, and glycaemic control were compared. In total, 5644 T2DM patients were included. Three subgroups were established based on FCP levels: subtype T1 (FCP≤1.0μg/L), 1423 patients (25.21%); subtype T2 (FCP 1.0-2.5μg/L), 2914 patients (51.63%); and subtype T3 (FCP≥2.5μg/L), 1307 patients (23.16%). T1 was characterised by older age, lower body mass indices, higher initial glycosylated haemoglobin (HbA1c) levels, and the lowest homoeostatic model assessment 2 estimates of β-cell function (HOMA2-β) and HOMA2-insulin resistance at baseline. The T3 group's clinical characteristics were opposite to those of T1. T3 patients showed higher incidence rates and risks of diabetic kidney disease, diabetic peripheral vascular disease, and non-alcoholic fatty liver, while the risks of diabetic retinopathy and diabetic peripheral neuropathy were highest in T1. Insulin, glycosidase inhibitors, and thiazolidinedione were the most frequently used drugs, but the use of metformin, dipeptidyl peptidase-4 inhibitor, and insulin secretagogue drugs was slightly lower in T1. T1 maintained higher HbA1c levels throughout follow-up. Overall HbA1c fluctuations were more significant in T3 than in T1 and T2. The new adult T2DM classification is simple and clear and will help classify different T2DM clinical characteristics and guide treatment plans.

Clinical Features and T Cell Immune Characteristics of Postpartum Hepatitis Flare in Pregnant Women With HBeAg-Positive Chronic HBV Infection.

BackgroundThe extent of the increase in postpartum alanine transaminase (ALT) varies significantly among pregnant women in the immune tolerance stage of nucleoside analogue (NA) intervention, so this study is an attempt to analyze the clinical features of patients with and without postpartum hepatitis flare and preliminarily explore the differences in their immune functions.MethodsPregnant women with a gestational age of 24–28 w and in the immune tolerance stage of NA intervention for hepatitis B virus (HBV) infection were included and divided into a hepatitis group (Group 1) and a nonhepatitis group (Group 2) according to the ALT level at 6–12 w after childbirth. The clinical features were analyzed, and the phenotypes, functions, and cytokines of clusters of differentiation CD8+ T cells in the two groups of patients were detected using flow cytometry before and after childbirth.ResultsA total of 15 patients with postpartum hepatitis flare were enrolled in Group 1, and 10 matched patients were selected as controls for Group 2. Compared with the individuals in Group 2, the postpartum clinical features in Group 1 included a remarkable elevation of the ALT level on the basis of a relatively low HBV DNA level, usually accompanied by a decline in hepatitis B virus surface antigen levels as well as HBeAg levels. In addition, CD8+ T cell activation was enhanced after childbirth in Group 1. In particular, there was a notable difference in the activation of TEMRA subsets, and the frequency of CD8+ T cells expressing perforin and granzyme B increased.ConclusionThe changes in the immune characteristics of CD8+ T cells may play a certain role in breaking down immune tolerance in patients with postpartum hepatitis flare, and the indexes related to activating and killing functions may help to indicate the population with hepatitis flare after childbirth.

Clinical Features of Group B Streptococcus Colonization in Vagina During Late Pregnancy at a Primary Maternity Hospital

Purpose: The aim of this study was to assess the epidemiologic and clinical features of maternal Group B Streptococcus (GBS) colonization in vagina during their third trimester.Methods: This study included 644 pregnant women who had undergone GBS culture test in their third trimester in 2018. We collected data from the primary level of care maternity hospital through the retrospective chart review. We compared patients’ demographics, maternal obstetrical complications and neonatal adverse events between GBS positive (n=41) and GBS negative (n=603) groups. To find out clinical predictors of GBS positive result, univariable chi-square test and multivariable logistic regression analysis were applied.Results: The colonization rate of GBS in maternal vagina was 6.4% in their third trimester. GBS positive group showed significant association with the third trimester anemia (hemoglobin level &lt;10.5 g/dL) (p=0.013) and oligohydramnios (p=0.024; odds ratio, 7.32; 95% confidence interval, 1.28–41.31). All specimens were susceptible to penicillin G and cephalosporin. The antibiotic resistance to both erythromycin and clindamycin was 31%.Conclusion: The colonization rate of GBS in maternal vagina was 6.4% and third trimester maternal anemia was associated with the GBS carrying status.

Epidemiology and Clinical Characteristics of Henoch–Schönlein Purpura Associated with Streptococcal Infection in 217 Children in Hubei Province, China

Objectives The objectives of present study were to analyze the association of the streptococcal infection with childhood Henoch–Schönlein purpura (HSP) in China. Methods: We performed a case-control study over a period of five years to evaluate the epidemiology and clinical characteristics of group A β-hemolytic streptococcal (GABHS) triggered HSP. Results: 1. The frequency of GABHS-triggered HSP was 15.1%, while that of GABHS infection developing HSP in children was 4.7%. 2.The epidemiological characteristics of HSP with streptococcal infection were similar to those of HSP alone. 3. The GABHS-triggered HSP cases had a significantly higher frequency of renal involvement than the noninfectious group. 4. IgA and IgG were significantly increased in the streptococcal infection group than in the noninfectious group, while the levels of C3 and C4 decreased significantly. Conclusions: GABHS infection is the most frequent agent in HSP children, and may aggravate the immune dysfunction and prolong the course of HSP.

Oxycodone/Acetaminophen: The Tailoring Combination Treatment for Specific Clinical Profile of Opioid Well-Responsive Cancer Pain.

BackgroundInternational guidelines recommend moderate-to-severe cancer pain to be treated with strong opioids. However, pain management remains an unsolved matter, at least in the demanding oncology and palliative care setting. Although cancer pain consists of multiple components, which interact in complex ways where combination therapy can better intercept multiple pain characteristics, few studies have used a non-opioid/opioid association to exploit possible synergistic actions. Even the efforts of a recent approach emphasizing appropriate pain assessment and accurate classification to obtain personalized pain management have not produced a satisfactory analgesic strategy.ObjectiveThis analysis was intended to evaluate the effectiveness of the immediate release fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of moderate-to-severe intensity background pain used alone or in combination with other strong opioids in cancer patients with breakthrough cancer pain (BTcP). This is a secondary analysis of a wider observational, prospective, multicenter study [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] performed on 179 patients treated with opioids for cancer pain who received the fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of background pain (BGP).ResultsCancer patients with breakthrough cancer pain and controlled BGP (Background Pain) were classified according to the presence of analgesic therapy with tablets of fixed combination OxyIR/Par alone (group A, n=120) or tablets of fixed combination OxyIR/Par combined with other strong opioids (group B, n=59). Clinical features of group A were different to group B: higher mean Karnofsky Performance Status Index 70.3% (95% CI=67.2–73.5; median=70, CI=60–80) vs 58.3 (95% CI=53.4–63.2; median=50, CI=45–70) (P<0.001), and mainly group A patients were treated in an ambulatory setting (55.0% group A vs 33.9% group B) (p<0.001). Both groups had managed BGP with similar mean dosages (group A: 12.0, CI=10.5–13.4; group B: 13.1, CI=11.0–15.1) and frequencies of OxyIR/Par alone for group A and in association to other opioids for group B, but Breakthrough cancer Pain (BTcP) exhibited different characteristics in the two groups, showing a lower mean intensity numerical rating scale (NRS) of 7.5 (95% CI=7.2–7.7; median=7, CI=7–8 group A) vs 7.9 (95% CI=7.6, 8.2; median= 8, CI=7–9 group B) (P=0.04) and a higher percentage of patients had a faster onset, defined as the maximum intensity reached in less than 10 minutes, 81.7% (N=98) in group A vs 59.3% (n=35) in group B (P=0.002).ConclusionThis is the first analysis about the efficacy of an immediate-release fixed combination of OxyIR/Par in the real world for moderate-to-severe background cancer pain and breakthrough cancer pain. The oral fixed combination OxyIR/Par provided an adequate level of analgesia for moderate–severe background cancer pain, in a different cohort of cancer patients with different performance status, both in ambulatory and palliative settings. The low dosage of fixed combination OxyIR/Par was effective alone or in association with other opioids.

Potential Severe Asthma Hidden in UK Primary Care

Severe asthma may be underrecognized in primary care. Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care. This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared. Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA. Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.

Relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus

This study aimed to investigate the relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus (GDM). Clinical data of 298 cases of GDM delivered in Taizhou People’s Hospital from January 2017 to June 2018 were retrospectively analyzed. According to the level of cystatin C before delivery, they were divided into normal group (≤ 1.1 mg/L) and elevated group (> 1.1 mg/L). The general situation, complications of pregnancy, and the incidence of abnormal glucose tolerance at 6 weeks after delivery were compared between the two groups. According to concomitant gestational hypertension in late pregnancy, the patients were divided into group A (GDM with hypertensive disorder complicating pregnancy (HDCP)) and group B (GDM without HDCP). The differences of age, parity, body mass index (BMI) and mean arterial pressure (MAP) in the first trimester of pregnancy, levels of cystatin C, creatinine, urinary microalbumin, and glycosylated hemoglobin in 24-week gestation and before delivering were compared between the two groups. There was no significant difference in age and parity between the normal group and the elevated group (p > 0.05). The levels of BMI (25.06 ± 3.46 vs 26.34 ± 3.65 kg/m2), creatinine (38.76 ± 16.52 vs 59.75 ± 17.82 mmol/L), and urinary microalbumin (37.11 ± 49.20 vs 61.25 ± 43.52 mg/L) and the incidence of premature delivery (9.35% vs 17.8%), premature rupture of membranes (11.22% vs 20.94%), and abnormal glucose tolerance at 6-week postpartum (18.69% vs 42.93%) in the normal group of cystatin C were significantly lower than that in the elevated group of cystatin C (p 0.05). The clinical characteristics of group A (GDM with HDCP) and group B (GDM without HDCP) were compared. The results showed that the levels of age, BMI, and mean arterial pressure (MAP) were significantly different (p < 0.001). The results of binary logistic regression analysis showed that the significance value of MAP was 0.005 after controlling age factors, which indicated that MAP was an independent risk factor of GDM with HDCP, and the OR value of MAP was 1.420 (1.109–1.817). The increase of cystatin C in patients with GDM does not increase the risk of HDCP, but it does increase the risks of premature delivery, PROM, and abnormal glucose tolerance at 6-week postpartum. Cystatin C is a biological index that may be valuable in predicting the occurrence of these diseases in GDM patients. The independent risk factor of GDM complicating HDCP is MAP.

Clinical Features of Group A Streptococcus in Children With Pharyngitis: Carriers versus Acute Infection.

Among children with pharyngitis who test positive for group A Streptococcus (GAS), 10%-25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from colonization. We examined 2 separate longitudinal studies of children with symptomatic pharyngitis associated with a positive GAS throat culture (illness culture). In cohort 1, children presented with pharyngitis symptoms to a clinician, then had follow-up cultures at regular intervals. In cohort 2, throat cultures were performed at regular intervals and with pharyngitis symptoms. Illness cultures were categorized as acute infection or carrier based on follow-up culture results. In cohort 2, carriers were further categorized as a GAS carrier with a new emm-type or a GAS carrier with a previous emm-type based on typing data from prior culture results. For each cohort, symptoms were compared at the time of illness culture between carriers and those with acute infection. Cohort 1 (N = 75 illness cultures): 87% of the children were classified as acutely infected versus 13% carriers. Carriers were more likely to have upper respiratory (URI) symptoms [odds ratio (OR): 5.5; 95% confidence interval (CI): 1.4-22.1], headache (OR: 6.0; 95% CI: 1.2-40.5) or vomiting (OR: 5.5; 95% CI: 1.2-24.5). Cohort 2 (N = 122 illness cultures): 79% were acutely infected and 21% were carriers. Children determined to be carriers with a previous detected emm-type were more likely to have URI symptoms compared with those with acquisition of a new emm-type. Children with symptomatic pharyngitis and GAS on throat culture identified as carriers were more likely to present with URI and atypical symptoms than children who were acutely infected.

Etiological serotype and genotype distributions and clinical characteristics of group B streptococcus-inducing invasive disease among infants in South China

BackgroundGroup B streptococcus (GBS)-induced invasive disease is a major cause of illness and death among infants aged under 90 days in China; however, invasive GBS infection remains unknown in China. We aimed to describe the serotype and genotype distributions of early-onset disease (EOD) and late-onset disease (LOD), and to show the clinical correlations among various GBS serotypes and genotypes obtained from infants with invasive GBS infections.MethodsBetween June 1, 2016 and June 1, 2018, 84 GBS strains were collected from patients younger than 90 days at seven Chinese hospitals. Clinical data were retrospectively reviewed. GBS serotyping was conducted and multi-locus sequence typing was performed.ResultsSerotypes Ia, Ib, II, III, and V were detected. Serotype III (60.71%) was the most common, followed by Ia (16.67%) and Ib (14.29%). Intrapartum temperature ≥ 37.5 °C, chorioamnionitis, and mortality were noted in 28.57, 42.86, and 28.57% of patients with serotype Ia, respectively, and these rates were higher than those in patients with serotypes Ib and III (P = 0.041, P = 0.031, and P = 0.023, respectively). The incidence of respiratory distress was lower (P = 0.039) while that of purulent meningitis was higher (P = 0.026) in the serotype III group. Eighteen sequence types were detected among isolates, and ST17 [42.86% (36/84)] was the most prevalent.ConclusionsGBS isolates belonging to serotypes Ia, Ib, and III are common in southern mainland China, and ST17 is highly prevalent. Differences were found in the clinical manifestations of invasive GBS disease induced by serotypes Ia and III.

National patterns of care for early-stage penile cancers in the United States: How is radiation and brachytherapy utilized?

PurposePer American Brachytherapy Society guidelines, cT1-2N0 penile cancers <4 cm in diameter are excellent candidates for curative brachytherapy. Using that criterion, we evaluated national patterns of care and predictors of use of radiation techniques using the National Cancer Database. Methods and MaterialsThe National Cancer Database was queried for men with cT1-2N0 penile cancers <4 cm in size. Comparative statistics for treatment modality were generated using bivariate logistic regression analysis. ResultsAmong 1235 cases eligible for analysis, median age was 69 years. Median tumor size was 2.0 cm. 95.8% of men underwent surgery alone, with 91 (7.4%) undergoing radical penectomy, 673 (54.5%) partial penectomy, and 419 (33.9%) cosmesis-preserving surgical procedure. Only 4 (0.3%) men were treated with brachytherapy alone, 48 (3.9%) with external-beam radiation therapy (EBRT) alone, and 8 (0.6%) with EBRT after surgery. Surgical margins were positive in 118 (9.6%) patients, 14 of whom received adjuvant EBRT (11.9%) and two adjuvant brachytherapy (1.7%).There was no difference in demographic or clinical characteristics in groups treated with surgery vs. radiation (all p > 0.2). Age >70, lesions >2 cm, and T2 tumors were more likely to undergo non–organ-preserving therapy vs. radiation or a cosmesis-preserving procedure (all p < 0.05). The propensity-matched 5-year survival was not different between definitive radiation vs. surgery (61.6% vs. 62.2%, p = 0.70). ConclusionsMen with penile-preserving eligible lesions in the United States are overwhelmingly treated with surgery. Penile-preserving radiation techniques including brachytherapy and EBRT are underutilized and should be offered as curative interventions.

Phenotypic Variability of Essential Tremor Based on the Age at Onset.

Essential tremor (ET) is reported to have a bimodal distribution of age at onset (AAO) with phenotypic variability based on the AAO. This study aims to explore the distribution of AAO based on mathematical modeling and ascertain the differences, if any, in the clinical features of groups. A chart review was conducted for 252 patients with ET diagnosed based on the Consensus statement of the Movement Disorder Society on Tremor. Finite mixture modeling was performed to identify groups of the cohort based on the AAO. Three groups were defined: early onset (EO): AAO ≤ 22 years, n = 63, intermediate onset (IO): 23 ≤ AAO ≤ 35 years, n = 43, and late onset (LO): AAO ≥ 36 years, n = 146. There were no significant differences related to family history or responsiveness to alcohol. The EO group had significantly higher prevalence of upper limb and lower limb tremor. Head tremor and voice tremor was more prevalent in the IO and LO groups. Cerebellar signs showed a significant increase with an increase in AAO. ET shows significant phenotypic variability based on the AAO. Patients with an early AAO are more likely to develop an appendicular tremor, whereas the probability of axial tremor and cerebellar signs increases with increasing AAO.

Comparative effects of atorvastatin 80 mg versus rosuvastatin 40 mg on the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte to HDL-cholesterol ratio in patients with acute myocardial infarction

Aim: Previous studies have shown the association between the elevated levels of hematological markers like Neutrophil to Lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR) and Monocyte to High density lipoprotein cholesterol (HDL-C) ratio (MHR) and increased risk of the existence of cardiovascular disease, increased risk of acute coronary syndromes and severity of cardiovascular disease. One of the most commonly used drugs in atherosclerotic cardiovascular diseases are statins and we know that statins have beneficial effects in addition to LDL-lowering effects known as pleiotropic effects. However the effects of statins on the hematological markers are unclear. We performed this investigation to clarify and compare the effects of maximum-dose of atorvastatin and rosuvastatin on hematological biomarkers in patients with acute myocardial infarction. Methods: Statin or other anti-lipid drugs naive patients with either ST-segment elevation myocardial infarction or Non-ST elevation myocardial infarction were enrolled to our study. Biochemistry parameters, lipid parameters, blood-count parameters and NLR, PLR and MHR levels were measured at baseline and 30 days after discharge. Baseline characteristics and results of 2 groups after one-month treatment were compared. Results: Among the 128 statin-naive patients included, 65 patients received atorvastatin (80 mg/day) and 63 patients recieved rosuvastatin (40 mg/day). Baseline clinical characteristics of groups were similar. Atorvastatin 80 mg significantly decreased the levels of NLR (p=0.001) and MHR (p=0.024) at the end of one-month therapy. Rosuvastatin 40 mg also significantly decreased the levels of NLR (p=0.001) and MHR (p=0.006) at the end of one-month therapy. Both statins were ineffective on the levels of PLR. Percent and absolute changes of NLR, MHR and PLR were similar and there were no statistically significant differences between both groups. The percent and absolute changes of lipid parameters were also similar among both treatment arms. Conclusion: Our results showed that atorvastatin 80 mg and rosuvastatin 40 mg decreased the NLR and MHR levels significantly at the end of one-month therapy. However, both statins have no effects on PLR levels.

Increased risk of group B Streptococcus causing meningitis in infants with mannose-binding lectin deficiency

ObjectivesTo evaluate the association of mannose-binding lectin (MBL) deficiency with susceptibility and clinical features of group B Streptococcus (GBS) causing meningitis in Chinese infants. MethodsDuring 2014–2017, 33 infants with laboratory-confirmed GBS meningitis were included. Six polymorphisms (H/L, Y/X, P/Q, A/D, A/B and A/C) of MBL were sought for in these patients and in 330 healthy controls by PCR-based sequencing. Serum MBL concentration was determined. ResultsSignificantly higher frequency of MBL variant genotype A/B was found in patients than controls (15/33, 45%, vs. 79/330, 24%, p=0.011). Patients with variant genotype A/B had significantly lower serum MBL than those with wild-type genotype A/A (median, 482.87 vs. 1455.13 ng/mL, p=0.002). Moreover, patients with genotype A/B had significantly higher level of C-reactive protein (median, 146 vs. 41 mg/L, p=0.007), neutrophil (median, 58.1% vs. 45.7%, p=0.033) and neutrophil-to-lymphocyte ratio in blood (median, 2.32 vs. 1.03, p=0.018) compared to those with genotype A/A. No significant differences were observed in clinical features of patients with different genotypes. ConclusionsOur result suggested that infants with MBL deficiency are at higher risk of meningitis caused by GBS. Further studies in different populations with larger number of subjects are needed.