Medicine
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Apatinib (Jiangsu HengRui Medicine Co. Ltd), a vascular endothelial growth factor receptor 2 (VEGFR-2) tyrosine kinase inhibitor, has been proven to be safe and to significantly prolong survival in advanced chemotherapy-refractory gastric cancer. This study aimed to assess and compare the efficacy and safety of apatinib combined with chemotherapy with that of chemotherapy alone as second- or higher-line treatment in patients with advanced and metastatic gastric or those with metastatic gastroesophageal junction adenocarcinoma (mGC). ⋯ Moreover, the incidence of Grade 3 to 4 hand-foot syndrome, proteinuria, and hypertension was significantly different between the 2 groups. Combined therapy (P = .040) and metastatic sites <2 (P = .008) were the independent prognostic factors for disease progression. Compared with chemotherapy alone, the addition of apatinib to chemotherapy could better improve PFS and DCR with an acceptable safety profile for mGC refractory to 1 or more line of prior chemotherapy.
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Osteoporosis (OP) is a common skeletal disorder worldwide, resulting in increased bone fragility and high risk of fractures. The Zuogui Pill (ZGP), a classic Chinese herbal formulation, has played a vital role in the clinical practice of OP in China for centuries. Increasing studies have been performed for clarifying its anti-osteoporotic mechanisms. However, this treatment still lacks a systematic review for its efficacy and safety in the treatment of OP. ⋯ The conclusion of the study will indicate whether ZGP is an effective treatment for OP by providing updated evidence.PROSPERO registration number: PROSPERO CRD 42018114366.
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Case Reports
PICC insertion in the sitting position for a patient with congestive heart failure: A case report.
A peripherally inserted central catheter (PICC) is typically inserted with the patient in the supine position. Here, we placed a PICC in a patient in the sitting position, in order to treat congestive heart failure. ⋯ The technique of inserting a PICC in the sitting position is simple and feasible. This approach may be useful for patients in whom central venous access is needed, but the supine position cannot be achieved.
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The 1st exon 5' noncoding region rs1799946 (-52A/G), rs1800972 (-44C/G), rs11362 (-20A/G) 3 single-nucleotide polymorphisms (SNPs) on human β-defensin-1 (HBD-1) gene affect its transcription and posttranscriptional mRNA stability then affect the activity of HBD-1. This study was to investigate the effects of HBD-1 gene rs1799946, rs1800972, and rs11362 locus SNPs on genetic susceptibility and prognosis of acute respiratory distress syndrome (ARDS). ⋯ The SNP of rs1800972 (-44C/G) in HBD-1 gene is associated with the risk of ARDS. The rs1800972 locus G allele carriers are more likely to develop ARDS and have a poor prognosis.
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Observational Study
Heart rate variability based machine learning models for risk prediction of suspected sepsis patients in the emergency department.
Early identification of high-risk septic patients in the emergency department (ED) may guide appropriate management and disposition, thereby improving outcomes. We compared the performance of machine learning models against conventional risk stratification tools, namely the Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and our previously described Singapore ED Sepsis (SEDS) model, in the prediction of 30-day in-hospital mortality (IHM) among suspected sepsis patients in the ED. Adult patients who presented to Singapore General Hospital (SGH) ED between September 2014 and April 2016, and who met ≥2 of the 4 Systemic Inflammatory Response Syndrome (SIRS) criteria were included. ⋯ A total of 214 patients were included, of whom 40 (18.7%) met the outcome. Gradient boosting was the best model with a F1 score of 0.50 and AUPRC of 0.35, and performed better than all the baseline comparators (SEDS, F1 0.40, AUPRC 0.22; qSOFA, F1 0.32, AUPRC 0.21; NEWS, F1 0.38, AUPRC 0.28; MEWS, F1 0.30, AUPRC 0.25). A machine learning model can be used to improve prediction of 30-day IHM among suspected sepsis patients in the ED compared to traditional risk stratification tools.