Impact of individual molecular components in determining primary sensitization to latex

Allergy to natural rubber latex emerged as one of the main allergies at the beginning among some professional groups and the general population. Sensitization and development of latex allergy have been attributed to exposure to products containing residual latex proteins. The prevailing cross-reactivity of latex proteins with other food allergens is of great concern. Numerous purified allergens are currently available, which greatly help in patient management, thus determining their specific profile. We conducted a multicenter study to investigate changes, from the ROC analysis, in the characteristics of patients with latex allergy by measuring its major protein components. Sensitization to latex proteins is crucial because it highlights the cross reactivity to inhalants (pollen) and food (fruit). It is very essential in an accurate and specific clinical setting.     

Combined effects of high sensitivity C-reactive protein and triglyceride–glucose index on risk of cardiovascular disease among middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study

Background and aimsHigh sensitivity C-reactive protein (hsCRP) and triglyceride glucose (TyG) index were proved to be independent risk factors of cardiovascular disease (CVD). However, individual hsCRP or TyG index might not provide sufficient predictive value on CVD risk. The current study aimed to evaluate the cumulative effect of hsCRP and TyG index on CVD risk prospectively.Methods and resultsA total of 9626 participants were enrolled in the analysis. The TyG index was calculated as ln(triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The primary outcome was new-onset CVD events (cardiac events or stroke), and the secondary outcomes were new-onset cardiac events and stroke, separately. Participants were divided into 4 groups through the median of hsCRP and TyG index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportion hazard models. From 2013 to 2018, 1730 participants experienced CVD (570 stroke and 1306 cardiac events). Linear associations were found between hsCRP, TyG index, hsCRP/TyG ratio and CVD (all p < 0.05). Compared to participants with low hsCRP/low TyG index, multivariable adjusted HRs (95% CIs) for those with high hsCRP/high TyG index were 1.17 (1.03–1.37) for CVD. No interaction of hsCRP and TyG index was found on CVD (p_-interaction ≥0.05). Furthermore, adding hsCRP and TyG index simultaneously to conventional risk model improved risk reclassification for CVD, stroke and cardiac events (all p < 0.05).ConclusionThe present study suggested combination of hsCRP and TyG index might better improved the ability for risk stratification of CVD among middle-aged and older Chinese.     

Towards understanding Müller-Weiss disease from an analysis of 95 cases

BackgroundThe single existing classification of Müller-Weiss Disease (MWD), based solely upon Méary’s angle, serves neither as guide for prognosis nor treatment. This accounts for lack of gold standard in its management.MethodsNavicular compression, medial extrusion, metatarsal lengths, Kite’s, lateral and dorsoplantar talo-first metatarsal angles were measured in 95 feet with MWD. Joints involved, presence and location of navicular fracture were recorded.ResultsGroup 1 “early-onset” MWD feet (n = 11) had greatest compression and medial extrusion, and lowest Kite’s angles. All except 1 were index minus and had lateral navicular fracture. Only 1 had moderate degeneration at the talonavicular joint (TNJ) with none requiring surgery yet.Group 2 “Müller-Weissoid” feet (n = 23) had radiologically normal navicular in their fifties and developed MWD on average 5 years later. They had the lowest compression and extrusion, and highest Kite’s angles. None had complete fracture. All had TNJ arthritis, with early changes at lateral naviculocuneiform joint (NCJ) in 43%.Group 3 “late-onset” MWD presented in the sixth decade. Only TNJ was involved in Group 3 A (n = 16). Group 3B (n = 20) affected TNJ more than NCJ and had the greatest number of Maceira stage V disease. Group 3 C “reverse Müller-Weiss disease”, which affected NCJ more than TNJ (n = 25), had greatest midfoot abduction and overlength of the second metatarsal. No fracture occurred in group 3 A compared to 65% and 32% in groups 3B and 3 C, respectively.ConclusionsWith need to compare like-for-like pathology, the proposed classification provides a common platform for reporting outcomes of different treatments. We theorize pathogenetic pathways in the various groups.     

Skeletal muscle mass is a strong predictor of cardiorespiratory fitness in the Chinese population with obesity

Background and aimsAlthough skeletal muscle is well-known as physiologically related to VO₂max, the independent predictive value of skeletal muscle mass (SMM) VO₂max in people with obesity has not been studied. This study aims to determine the relationships between maximal oxygen uptake (VO₂max) and SMM in the Chinese population with obesity.Methods and resultsOverall, 409 participants with obesity were included in this cross-sectional study. A maximal and graded exercise testing measured VO₂max, and body compositions were measured by bioelectrical impedance analysis. Subsequently, correlation coefficients and stepwise multiple linear regression analyses were used to determine the relationships between VO₂max and body compositions. SMM was found to have a significant correlation with VO₂max (r = 0.290, P < 0.001) after adjusting for sex, age, body mass index (BMI), waist-to-hip ratio, and percent body fat (PBF). In previous studies, BMI was widely recognized as a strong predictor of VO₂max. This study revealed surprising results: after SMM was controlled, the correlation between BMI and VO₂max was reduced (from r = 0.381, P < 0.001 to r = 0.191, P < 0.001). SMM was found the most important independent predictor. In the regression model, the variance of VO₂max was explained by the SMM which accounted for 27.4%.ConclusionsIn summary, SMM is a stronger independent predictor of cardiorespiratory fitness in the Chinese population with obesity than sex, age, BMI, waist-to-hip ratio, and PBF.     

The management and outcome of cryptococcosis in patients with different immune statuses and treatment protocols: A multicenter real-world study in Jiangsu Province - China

ObjectiveThe incidence of cryptococcosis is increasing in non-immunocompromised patients. However, the evidence on proper management is inadequate in this population. We conducted this multi-center real-world study in pulmonary cryptococcosis patients with different immune statuses, so as to provide practical evidence for optimized clinical management of cryptococcosis, especially for mild-to-moderate immunodeficient diseases patients.MethodsThis is a prospective observational study. The clinical data of patients with proven cryptococcosis were collected and analyzed from 7 tertiary teaching hospitals in Jiangsu Province, China from January, 2013 to December, 2018. Proven cases include pulmonary cryptococcosis, cryptococcal meningitis, cryptococcemia and cutaneous cryptococcosis. Patients were followed up over 24 months. According to their immune status, patients with cryptococcosis were divided into three groups, namely immunocompetent group (IC), mild-to-moderate immunodeficient diseases group (MID), severe immunodeficient diseases group (SID). Meanwhile, pulmonary crypotococcosis (PC) and extrapulmonary crypotococcosis (EPC) were also classified and analyzed.Results255 proven cases of cryptococcosis were enrolled. Finally, 220 cases completed the follow-up. 143 proven cases (65.0%) were immunocompetent (IC), 41 cases (18.6%) were MID, and 36 cases (16.4%) were SID. 174 cases (79.1%) were PC and 46 cases (20.9%) were EPC. The mortality was significantly higher in SID and MID patients [47.2% (SID) vs. 12.2% (MID) vs. 0.0% (IC), p<0.001]. The mortality was also significantly higher in EPC patients [45.7% vs. 0.6% (PC), p<0.001]. Patients with alternative initial antifungal treatment had higher mortality than patients with guideline recommended initial treatment [23.1% vs. 9.5%, p=0.041]. In MID group, the mortality of receiving alternative initial antifungal treatment was significantly higher than recommended initial treatment [2/3 vs. 3/34(8.8%), p=0.043]. In pulmonary cryptococcosis patients with MID, the mortality was very similar to IC group [0.0% vs. 0.0% (IC)], lower than SID group [0.0% vs. 11.1% (SID), p=0.555]. However, in extrapulmonary cryptococcosis patients with MID, the mortality was significantly higher than that in IC [62.5% vs. 0.0% (IC)], and similar to SID patients [62.5% vs. 59.3% (SID)].ConclusionThe immune status exert a significant influence on the management and prognosis of cryptococcosis patients. The mortality of cryptococcosis patients with MID is higher than that of immunocompetent patients. For MID patients with pure pulmonary cryptococcosis, it is acceptable to take the treatment recommended as IC patients. For the MID patients with extrapulmonary cryptococcosis, the mortality is high and the initial treatment should follow the regimen for SID patients. Following the recommended treatment regimen in the IDSA guideline can reduce mortality in patients with cryptococcosis. Starting on alternative initial antifungal treatment may bring worse outcomes.     

地塞米松通过抑制p53蛋白降解诱导成骨细胞凋亡

目的 观察地塞米松对成骨细胞凋亡的影响并探讨其作用机制。方法 分别采CellTiter-Glo?荧光细胞活力检测试剂盒和Annexin V-FITC/PI双染凋亡检测试剂盒测定地塞米松作用后MC3T3-E1细胞的增殖和凋亡。蛋白质印迹法(Western blotting)检测地塞米松作用后MC3T3-E1细胞和hFOB1.19细胞胱天蛋白酶3(caspase-3)/裂解caspase-3和PARP/裂解PARP的表达。用Western blotting和PCR分析地塞米松作用后MC3T3-E1细胞中p53和检控点激酶2(Chk2)的表达。探讨p53敲除和Chk2敲除在地塞米松诱导MC3T3-E1细胞凋亡中的作用。结果 地塞米松能显著抑制MC3T3-E1细胞的生长并诱导其凋亡。地塞米松能通过促进p53的表达诱导成骨细胞凋亡。地塞米松对P53蛋白表达的调节作用是通过上调Chk2来实现的，Chk2与P53相互作用，抑制P53蛋白的降解。P53基因敲除可通过降低裂解caspase-3和裂解PARP的表达来抑制地塞米松诱导的MC3T3-E1细胞凋亡，经Dex处理的MC3T3-E1和hFOB1.1...     

Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis

BackgroundThe Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with Insertional Achilles Tendinopathy (IAT) that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT.MethodsPubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95 % confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4).ResultsTen studies with 232 patients were included. Functional scores and pain levels were significantly improved after the Zadek osteotomy (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia.ConclusionsThe Zadek osteotomy is a safe and effective procedure for patients with IAT. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this.Level of evidenceII.     

乙酰胆碱受体抗体及兰尼碱受体抗体双阳性新生儿短暂性重症肌无力1例

目的 探讨乙酰胆碱受体（AChR）抗体和兰尼碱受体（RyR）抗体双抗体阳性新生儿短暂性重症肌无力（TNMG）病儿的临床特点、诊疗和预后。方法 回顾性分析南京医科大学附属连云港医院2021年3月收治的1例AChR与RyR双抗体阳性TNMG的临床资料，并复习相关文献，为早期识别提供临床思路。结果 男，30 min，因“气促、呻吟30 min”入院，入院第2天出现呼吸困难逐渐加重，提高氧饱和度仍不能维持在正常范围，自行进奶差，吸吮能力差，偶有吐奶，哭声低。新斯的明试验阳性，神经肌肉疾病检测提示AChR抗体和RyR抗体阳性，其母有3年重症肌无力病史。予气管插管机械通气，鼻饲奶喂养，溴吡斯的明片口服等治疗15 d，病儿病情好转出院，出院后门诊随访至3个月，病儿吃奶好，智力及体格发育在正常范围。结论重症肌无力母亲分娩的新生儿均应转入新生儿重症监护室密切监护，且有TNMG病史的婴儿应长期随访。     

Lingual nerve impairment/injury after retrieval of the displaced mandibular third molar into the floor of the mouth

Retrieval of the displaced mandibular third molar in the floor of the mouth is challenging as the lingual nerve is always at risk of injury. However, there are no available data to show the incidence of the injury caused by the retrieval. The goal of this review article is to provide the incidence of the iatrogenic lingual nerve impairment/injury caused by the retrieval based on the review of the existing literature. The retrieval cases were collected with the search words below using PubMed, Google Scholar, and CENTRAL Cochrane Library database on October 6, 2021. A total of 38 cases of lingual nerve impairment/injury in 25 studies were eligible and reviewed. Temporary lingual nerve impairment/injury due to retrieval was found in six cases (15.8%) and all recovered between three to six months after retrieval. General anaesthesia and local anaesthesia were used for retrieval in three cases each. The tooth was retrieved using a lingual mucoperiosteal flap in all six cases. The permanent iatrogenic lingual nerve impairment/injury due to retrieval of the displaced mandibular third molar is considered extremely rare as long as the appropriate surgical approach is chosen based on surgeons’ clinical experience and anatomical knowledge.