The relationship between rehabilitation motivation and upper limb motor function in stroke patients

Objective

Insufficient motivation among post-stroke survivors may be an important factor affecting their motor function recovery. This study seeks to investigate the relationship between motivation and functional recovery in stroke patients undergoing rehabilitation training.

Materials and methods

103 stroke patients with upper limb impairments were studied during their hospital stays. Assessments were done before and after rehabilitation training to measure motivation, emotional state, motor function, and independence in daily activities. Data analysis was conducted to examine the distribution of these factors among the participants. Pearson and Spearman correlation analyses were used to study the relationships between motivation, emotional state, and motor function. Patients were divided into high and low motivation groups based on the Rehabilitation Motivation Scale (RMS), and chi-square and rank-sum tests were used to compare functional differences before and after treatment among patients with varying levels of motivation.

Results

66 participants were found to have low motivation in the initial assessment of the RMS (64.08%). Consistency in motivation levels was observed among patients with high motivation (r = 0.648, P<0.001). Apathy was identified as the main factor affecting motivation in patients with low motivation (p = 0.027), while depression and anxiety were not significantly correlated. Motivation was strongly linked to improvements in upper limb motor function, daily living activities, and self-exercise duration (p < 0.001) for stroke patients undergoing rehabilitation. Post-training, there was a notable increase in motivation, motor function, and independence in daily activities (p < 0.001). Increased rehabilitation motivation was linked to better upper limb motor function and daily independence in patients, particularly those with low motivation. This correlation was significant for both the FMA-UE and FIM scores.

Discussion

Old patients with poor upper limb motor function often have low motivation, which hinders their recovery. Using strategies to boost motivation in stroke patients with impaired upper limb function could greatly improve their rehabilitation and motor skills. It is crucial to prioritize these intervention strategies.

Conclusion

Enhancing rehabilitation motivation in stroke patients with low motivation and upper limb motor impairments can foster the restoration of their functional capabilities.

[Progress in methodological research on bridging the efficacy-effectiveness gap of clinical interventions(2): to improve the extrapolation of efficacy]

Objective: Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings. Methods: Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results: A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics. Conclusions: Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.

Design, synthesis, and biological evaluation of piperazine derivatives as pan-PPARs agonists for the treatment of liver fibrosis

Liver fibrosis is commonly occurred in chronic liver diseases, but there is no approved drug for clinical use. The nuclear receptor peroxisome proliferator-activated receptors (PPARs) could not only regulate metabolic homeostasis but also possess anti-inflammatory and antifibrotic effects, and pan-PPARs agonist was considered as a potential anti-liver fibrosis agent. In this study, a series of novel piperazine pan-PPARs agonists were developed, and the preferred compound 12 displayed potent and well-balanced pan-PPARs agonistic activity. Moreover, compound 12 could dose-dependently stimulate the PPARs target genes expression and showed high selectivity over other related nuclear receptors. Importantly, compound 12 exhibited excellent pharmacokinetic profiles and good anti-liver fibrosis effects in vivo. Collectively, compound 12 holds promise for developing an anti-liver fibrosis agent.

[Progress in methodological research on bridging the efficacy-effectiveness gap of clinical interventions (1): to improve the validity of real-world evidence]

Objective: Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect. Methods: Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results: Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap. Conclusion: Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Identifying canonical and replicable multi-scale intrinsic connectivity networks in 100k+ resting-state fMRI datasets

Despite the known benefits of data-driven approaches, the lack of approaches for identifying functional neuroimaging patterns that capture both individual variations and inter-subject correspondence limits the clinical utility of rsfMRI and its application to single-subject analyses. Here, using rsfMRI data from over 100k individuals across private and public datasets, we identify replicable multi-spatial-scale canonical intrinsic connectivity network (ICN) templates via the use of multi-model-order independent component analysis (ICA). We also study the feasibility of estimating subject-specific ICNs via spatially constrained ICA. The results show that the subject-level ICN estimations vary as a function of the ICN itself, the data length, and the spatial resolution. In general, large-scale ICNs require less data to achieve specific levels of (within- and between-subject) spatial similarity with their templates. Importantly, increasing data length can reduce an ICN's subject-level specificity, suggesting longer scans may not always be desirable. We also find a positive linear relationship between data length and spatial smoothness (possibly due to averaging over intrinsic dynamics), suggesting studies examining optimized data length should consider spatial smoothness. Finally, consistency in spatial similarity between ICNs estimated using the full data and subsets across different data lengths suggests lower within-subject spatial similarity in shorter data is not wholly defined by lower reliability in ICN estimates, but may be an indication of meaningful brain dynamics which average out as data length increases.

Predicting Radiation Esophagitis using 18F-FAPI-04 PET/CT in Patients with LA-ESCC Treated with Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

This prospective study examined whether 18F-FAPI-04 PET/CT can predict the development and severity of radiation esophagitis (RE) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) treated with concurrent chemoradiotherapy.

MATERIALS/METHODS

From June 2021 to March 2022, images were prospectively collected from LA-ESCC patients who underwent 18F-FAPI-04 PET/CT examinations before and during radiotherapy. The development of RE was evaluated weekly according to Radiation Therapy Oncology Group criterion. The target-to-background ratio in blood (TBRblood) was analyzed at each time point and correlated with the onset and severity of RE. Factors that predicted RE were identified by multivariate logistic analyses.

RESULTS

Thirty patients (median age, 66.5 years [interquartile range: 56¨C71 years]; 22 men) were evaluated. Significantly higher TBRblood (during radiotherapy, mean: 3.06 vs 7.11, P = 0.003) and change in TBRblood compared with pre-RT (ΔTBRblood, mean: 0.67 vs 4.81, P = 0.002) were observed in patients with RE than patients without RE. Those with grade 3 RE had a significantly higher TBRblood (during radiotherapy, mean: 4.55 vs 9.66, P = 0.003) and ΔTBRblood (mean: 2.16 vs 7.50, P = 0.003) compared with those with RE

CONCLUSION

The ΔTBRblood on 18F-FAPI-04 PET/CT may be effective at identifying patients at risk for the development of RE, especially grade 3 RE.

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Spatial Dynamic Subspaces Encode Sex-Specific Schizophrenia Disruptions in Transient Network Overlap and its Links to Genetic Risk

Background

Recent advances in resting-state fMRI allow us to study spatial dynamics, the phenomenon of brain networks spatially evolving over time. However, most dynamic studies still use subject-specific, spatially-static nodes. As recent studies have demonstrated, incorporating time-resolved spatial properties is crucial for precise functional connectivity estimation and gaining unique insights into brain function. Nevertheless, estimating time-resolved networks poses challenges due to the low signal-to-noise ratio, limited information in short time segments, and uncertain identification of corresponding networks within and between subjects.

Methods

We adapt a reference-informed network estimation technique to capture time-resolved spatial networks and their dynamic spatial integration and segregation. We focus on time-resolved spatial functional network connectivity (spFNC), an estimate of network spatial coupling, to study sex-specific alterations in schizophrenia and their links to multi-factorial genomic data.

Results

Our findings are consistent with the dysconnectivity and neurodevelopment hypotheses and align with the cerebello-thalamo-cortical, triple-network, and frontoparietal dysconnectivity models, helping to unify them. The potential unification offers a new understanding of the underlying mechanisms. Notably, the posterior default mode/salience spFNC exhibits sex-specific schizophrenia alteration during the state with the highest global network integration and correlates with genetic risk for schizophrenia. This dysfunction is also reflected in high-dimensional (voxel-level) space in regions with weak functional connectivity to corresponding networks.

Conclusions

Our method can effectively capture spatially dynamic networks, detect nuanced SZ effects, and reveal the intricate relationship of dynamic information to genomic data. The results also underscore the potential of dynamic spatial dependence and weak connectivity in the clinical landscape.

Search for the Majorana Nature of Neutrinos in the Inverted Mass Ordering Region with KamLAND-Zen

The KamLAND-Zen experiment has provided stringent constraints on the neutrinoless double-beta (0νββ) decay half-life in ^{136}Xe using a xenon-loaded liquid scintillator. We report an improved search using an upgraded detector with almost double the amount of xenon and an ultralow radioactivity container, corresponding to an exposure of 970 kg yr of ^{136}Xe. These new data provide valuable insight into backgrounds, especially from cosmic muon spallation of xenon, and have required the use of novel background rejection techniques. We obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>2.3×10^{26}  yr at 90% C.L., corresponding to upper limits on the effective Majorana neutrino mass of 36-156 meV using commonly adopted nuclear matrix element calculations.

Thrombectomy Using the EmboTrap Clot-Retrieving Device for the Treatment of Acute Ischemic Stroke: A Glimpse of Clinical Evidence

BACKGROUND

The EmboTrap Recanalization Device is a novel stent retriever for thrombectomy in the setting of acute ischemic stroke due to large-vessel occlusion.

PURPOSE

Our aim was to summarize the safety and efficacy of the EmboTrap Recanalization Device in acute ischemic stroke-large-vessel occlusion through a systematic review and meta-analysis.

DATA SOURCES

Medline, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were searched up to April 2022.

STUDY SELECTION

Nine observational studies using the EmboTrap Recanalization Device were selected.

DATA ANALYSIS

We adapted effect size with 95% CIs for dichotomous data. P value <.05 was statistically significant.

DATA SYNTHESIS

The estimated rate of successful recanalization (modified TICI 2b-3) was 90% (95% CI, 86%-95%; I ² = 82.4%); 90-day favorable outcome (mRS 0-2), 53% (95% CI, 42%-63%; I ² = 88.6%); modified first-pass effect, 43% (95% CI, 35%-51%; I ² = 63.7%); and first-pass effect, 36% (95% CI, 29%-46%; I ² = 10.7%). The rate of any intracerebral hemorrhage was 19% (95% CI, 16%-22%; I ² = 0.0%); symptomatic intracerebral hemorrhage, 5% (95% CI, 1%-8%; I ² = 84.6%); and 90-day mortality, 14% (95% CI, 9%-19%; I ² = 79.3%). Subgroup analysis showed higher rates of complete recanalization for EmboTrap II than for the EmboTrap System.

LIMITATIONS

The included studies are single-arm without direct comparison with other stent retrievers. Some of the studies recruited had a small sample size and were limited by the retrospective study design. In addition, the uncertain heterogeneity among studies was high.

CONCLUSIONS

The EmboTrap Recanalization Device is safe and efficient in treating acute ischemic stroke due to large-vessel occlusion.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 1)]

In recent years, researchers, pharmaceutical companies, and political makers gradually using more real-world data (RWD) to produce real-world evidence (RWE) for policy-making. A research team of Harvard University launched the RCT DUPLICATE project in 2018, aiming to replicate 30 randomized controlled trials using the medical claims database in order to explore methods for quantifying the efficacy-effectiveness gap and explain its potential sources, to enhance the credibility of the RWE. This paper reviews the background of RCT DUPLICATE Initiative, highlights the research purposes, research design and implementation process of the RCT DUPLICATE Initiative, to help domestic scholars better understand the scope and application value of RWE.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 2)]

With the promotion and application of big medical data, non-interventional real-world evidence (RWE) has been used by regulators to assess the effectiveness of medical products. This paper briefly introduces the latest progress and research results of the RCT DUPLICATE Initiative launched by the research team of Harvard University in 2018 and summarizes relevant research experience based on the characteristics of China's medical service to provide inspiration and reference for domestic scholars to conduct related RWE research in the future.

[Sorafenib regulates vascular endothelial growth factor by runt-related transcription factor-3 to inhibit angiogenesis in hepatocellular carcinoma]

Objective: To investigate the molecular mechanism of sorafenib against hepatocellular carcinoma. Methods: Sorafenib efficacy was screened and verified by the hepatocellular carcinoma patient-derived tumor xenograft (PDX) model. Veterinary B-mode ultrasonography and in vivo confocal laser scanning microscopy were used to observe PDX angiogenesis. Immunohistochemistry was used to observe the expression of proliferation and angiogenesis-related proteins in PDX tissue. Real-time quantitative PCR technology was used to observe the RUNX3 gene in PDX tissues. SPSS 17.0 statistical software was used for statistical analysis. Results: Four cases of PDX were used to screen the efficacy of sorafenib. PDX1 had a significant response to sorafenib, with an inhibition rate of 68.07%. Compared with the control group, sorafenib had significantly inhibited PDX1 relative tumor volume (5.76±2.14 vs. 11.71±2.87, P<0.05). Cell division index (39.50±7.72 vs. 67.10±9.14, P<0.05) and Ki67 expression (288.6±43.40 vs. 531.70±55.60, P<0.05) were significantly decreased. Veterinary B-mode ultrasonography showed evident blood flow signals in PDX1 tumors. In vivo confocal laser scanning microscopy results showed that sorafenib had significantly reduced the total vessel length (1573.00±236.21 vs. 2675.03±162.00, P<0.05) and area (11 145.33±1931.97 vs. 20 105.37±885.93, P<0.05)) of PDX1 tumors. Immunohistochemical results showed that sorafenib had significantly down-regulated the protein expressions of CD34 (27.55±3.76 vs. 45.47±5.57, P<0.05), VEGF (16.33±2.86 vs. 22.77±3.20, P<0.05) and MVD (38.75±6.01 vs. 55.50±8.61, P<0.05). Real-time PCR results showed that sorafenib had significantly up-regulated RUNX3 gene expression (2.14±0.71 vs. 1.00±0.36, P<0.05). However, there was a negative correlation between the expression of RUNX3 gene and the ratio of VEGF-positive cells in sorafenib group (R²=0.509 7). Conclusion: Sorafenib may inhibit the PDX angiogenesis and the growth of hepatocellular carcinoma by regulating the RUNX3-VEGF pathway.

ASSOCIATION BETWEEN THE CTLA-4 EXON 1+49A/G POLYMORPHISM AND THE RELAPSE OF GRAVE'S DISEASE AFTER ATD WITHDRAWAL: A META-ANALYSIS

Background

The cytotoxic T lymphocyte-associated molecules-4 (CTLA-4) is related to the relapse of Graves' disease (GD) after anti-thyroid drugs (ATDs) withdrawal. We performed a meta-analysis to generate large-scale evidence on whether the CTLA-4 exon 1+49A/G polymorphism can predict the relapse of GD after ATDs withdrawal.

Methods and Results

The PubMed, EMBASE,the Cochrane Library and reference lists of relevant studies were searched to identify eligible studies from inception to Jan, 2021. Ten eligible studies consisting of 1450 GD patients with a total of 848 relapsed patients were included in the meta-analysis.In Caucasians patients, the CTLA-4 exon 1+49A/G polymorphism significantly elevated the relapse risk of GD in additive (OR = 2.07, 95% CI: 1.18-3.62, P=0.011), dominant (OR = 2.52, 95% CI: 1.17-5.41, P=0.02), homozygote model(OR = 3.264, 95% CI: 1.25-8.52, P=0.016), except recessive (OR = 2.18, 95% CI = 0.98-4.86, P = 0.062) and heterozygote model (OR = 2.141, 95% CI = 0.958-4.786, P = 0.064). In Asian subgroup, none of these genotypes show any associations with the relapse of GD after ATDs withdrawal.

Conclusion

This meta-analysis suggests that the CTLA-4 exon1 +49A/G polymorphism is associated with the relapse risk of GD after ATDs withdrawal in Caucasians, not Asians. Compared with the AA genotype, Caucasian patients with GG genotype have 3.264 times risk of relapse. A more aggressive treatment such as radioactive iodine or thyroidectomy, or longer periods treatment of ATDs should be recommended in Caucasian patients with the GG genotype.

LB0005 ORELABRUTINIB, AN IRREVERSIBLE INHIBITOR OF BRUTON’S TYROSINE KINASE (BTK), FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PHASE IB/IIA DOSE-FINDING STUDY

Background

Orelabrutinib is an oral, highly-selective, irreversible inhibitor of Bruton’s tyrosine kinase (BTK). Orelabrutinib has been approved for the treatment of B cell malignancies in China. Two distinct lupus animal models showed significant efficacy of orelabrutinib in reducing disease activity, which supported the clinical development of orelabrutinib in Systemic Lupus Erythematosus (SLE).

Objectives

This phase Ib/IIa, randomized, double-blind, placebo-controlled, dose-finding study aimed to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), preliminary efficacy and biomarkers of orelabrutinib in patients with mild to moderate SLE who received standard of care (SoC) therapy.

Methods

Patients diagnosed with SLE by the ACR classification criteria for ≥ 6 months, who had a SLEDAI-2K score ≥5 at screening, and were autoantibody-positive, were randomized 1:1:1:1 to receive oral orelabrutinib at 50mg, 80mg, 100mg or placebo once daily for 12 weeks, respectively.

Results

This study randomized 60 patients with 55 patients who completed 12-week treatment. Age at baseline was 33.7±9.8 years and 96.7% were female. Baseline disease characteristics were generally balanced across treatment groups. Adverse events (AEs) were reported in 80%, 93.3% and 100% of orelabrutinib treated patients at doses of 50mg, 80mg and 100mg QD respectively versus 85.5% in placebo group. AEs were mostly mild or moderate. Treatment-related SAEs were reported in 3 patients treated with orelabrutinib, only 1 of which was grade 3. No deaths were reported. The plasma exposure of orelabrutinib (AUC and Cmax) was proportionally increased with doses. Nearly complete BTK occupancy was achieved at all dose levels, and the occupancy lasted for 24 hours without any decrease compared to that at 4 hour post-dosing. In all evaluable patients, the SLE Response Index (SRI)-4 response rates at week 12 were 50.0%, 61.5% and 64.3% in patients treated with orelabrutinib at 50mg (n=14), 80mg (n=13) and 100mg (n=14) respectively, compared with 35.7% in patients treated with placebo (n=14), which indicated the trend of dose-dependent improvement. Among the subgroup of patients with SLEDAI-2K≥8 at screening, SRI-4 response occurred in 70%, 70% and 66.7% of patients treated with orelabrutinib at 50mg (n=10), 80mg (n=10) and 100mg (n=9), respectively, compared with 30% who received placebo (n=10). Trends of reduced proteinuria, anti-dsDNA and IgG, total B cells and increased complements C4 were also observed following orelabrutinib treatment.

Conclusion

Orelabrutinib was generally safe and well tolerated in patients with SLE. Preliminary results also suggested encouraging efficacy which supports further development of orelabrutinib in larger and longer trials for SLE.

Table 1.

Efficacy results at week 12.

All Evaluable PatientsPlaceboOrelabrutinibOrelabrutinibOrelabrutinib50 mg80 mg100 mgN=5514141314SRI-4 response, n (%)5 (35.7%)7 (50.0%)8 (61.5%)9 (64.3%)Treatment difference vs. PBO (%)14.3%25.8%28.6%SLEDAI-2K≥8, N=391010109SRI-4 response, n (%)3 (30.0%)7 (70.0%)7 (70.0%)6 (66.7%)Treatment difference vs. PBO (%)40.0%40.0%36.7%

Note: All evaluable patients at week 12 efficacy data were included in the efficacy analysis.

Figure 1.

SRI-4 response rates at week 12.

Disclosure of Interests

Ru Li: None declared, Xiaoxia Zhu: None declared, Shengyun Liu: None declared, Xiao Zhang: None declared, Changhao Xie: None declared, Zili Fu: None declared, Anbin Huang: None declared, Lingyun Sun: None declared, Dongzhou Liu: None declared, Jinxia Zhao: None declared, Lin Wu: None declared, Zhoushuai Qin Employee of: InnoCare Pharma Limited., Sichen Li Employee of: InnoCare pharma Limited., Yaorong Liu Employee of: InnoCare pharma Limited., Zhanguo Li: None declared

Moving beyond the 'CAP' of the Iceberg: Intrinsic connectivity networks in fMRI are continuously engaging and overlapping

Resting-state functional magnetic resonance imaging is currently the mainstay of functional neuroimaging and has allowed researchers to identify intrinsic connectivity networks (aka functional networks) at different spatial scales. However, little is known about the temporal profiles of these networks and whether it is best to model them as continuous phenomena in both space and time or, rather, as a set of temporally discrete events. Both categories have been supported by series of studies with promising findings. However, a critical question is whether focusing only on time points presumed to contain isolated neural events and disregarding the rest of the data is missing important information, potentially leading to misleading conclusions. In this work, we argue that brain networks identified within the spontaneous blood oxygenation level-dependent (BOLD) signal are not limited to temporally sparse burst moments and that these event present time points (EPTs) contain valuable but incomplete information about the underlying functional patterns. We focus on the default mode and show evidence that is consistent with its continuous presence in the BOLD signal, including during the event absent time points (EATs), i.e., time points that exhibit minimum activity and are the least likely to contain an event. Moreover, our findings suggest that EPTs may not contain all the available information about their corresponding networks. We observe distinct default mode connectivity patterns obtained from all time points (AllTPs), EPTs, and EATs. We show evidence of robust relationships with schizophrenia symptoms that are both common and unique to each of the sets of time points (AllTPs, EPTs, EATs), likely related to transient patterns of connectivity. Together, these findings indicate the importance of leveraging the full temporal data in functional studies, including those using event-detection approaches.

[Mechanical circulatory support combined with immunomodulation treatment for patients with fulminant myocarditis: a single-center real-world study]

Objective: To investigate the relationship between the mechanical circulatory support (MCS) combined with immunomodulation and the prognosis of patients with fulminant myocarditis. Methods: This is a retrospective study. A total of 88 patients with fulminant myocarditis admitted to Dongguan Kanghua hospital from Aug. 2008 to Dec. 2020 were included. Medical histories, results of laboratory tests, treatment regimens and clinical outcomes of these patients during their hospitalization were collected from the medical record system. According to the treatment methods, the patients were divided into MCS+immunomodulation group (38 cases), MCS group (20 cases) and traditional treatment group (30 cases). Patients in the MCS+immunomodulation group received intra-aortic balloon pump (IABP) or IABP combined with extracorporeal membrane oxygenation (ECMO) and immunoglobulin or glucocorticoid. Patients in the MCS group only received mechanical circulatory support. Patients in the traditional treatment group received neither mechanical circulatory support nor immunomodulatory therapy, and only used vasoactive drugs and cardiotonic drugs. The in-hospital mortality and length of stay were compared among the three groups. Results: A total of 88 patients with fulminant myocarditis aged (35.0±10.8) years were included, and there were 46 males (52.3%). The mortality of MCS+immunomodulation group (7.9% (3/38) vs. 56.7% (17/30), P=0.001 2) and MCS group (30.0% (6/20) vs. 56.7% (17/30), P=0.002 8) were lower than that of traditional treatment group. Compared with the MCS group, the in-hospital mortality in the MCS+immunomodulation group was lower (P=0.005 4). The most common cause of death was multiple organ dysfunction syndrome (MODS). The constituent ratios of death in MCS+immunomodulation group, MCS group and traditional treatment group were 3/3, 4/6 and 12/17, respectively. The incidence of MODS in the MCS group (20% (4/20)) and the traditional treatment group (40% (12/30)) was significantly higher than that in the MCS+immunomodulation group (7.9% (3/38)) (both P<0.01). In discharged patients, the hospitalization time of MCS+immunomodulation group was shorter than that of traditional treatment group ((13.4±5.5)d vs. (18.5±7.4)d, P<0.05) and MCS group ((13.4±5.5)d vs. (16.9±8.5)d, P<0.05). Conclusion: MCS combined with immunomodulatory therapy is associated with lower in-hospital mortality and shorter hospital stay in patients with fulminant myocarditis.

Effect of pathological complete response after neoadjuvant chemoradiotherapy on postoperative complications of rectal cancer: a systematic review and meta-analysis

BACKGROUND

Standard total mesorectal resection has become an important treatment option for locally advanced or high-risk rectal cancer after neoadjuvant chemo-radiotherapy. 15-27% of patients can achieve pathological complete response (PCR) after neoadjuvant chemo-radiotherapy (nCRT). However, the relationship between PCR and postoperative complications remains an important unsolved problem. The objective of this study was to determine whether PCR was associated with the rate of postoperative complications.

METHODS

This meta-analysis was implemented following the recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched electronic literature by PubMed, EMBASE, and Google Scholar. Major outcomes of interest included anastomotic leakage, surgical-site infection, reoperation, and any postoperative complications. Other outcomes comprised postoperative hemorrhage, ileus, and mortality.

RESULTS

Eleven thousand two hundred ninety patients in 9 studies were included in the meta-analysis. The pooled analysis revealed that patients with PCR did not have a higher risk of anastomotic leakage (OR = 1.22, 95% CI 0.92-1.62, p = 0.17), reoperation (OR = 1.13, 95% CI 0.93-1.37, p = 0.22), and any postoperative complications (OR = 1.02, 95% CI 0.91-1.15, p = 0.72) than patients with non-PCR. However, the meta-analysis showed that the PCR group was superior to the non-PCR group in terms of surgical-site infection (9.38% vs. 12.44%OR = 0.68, 95% CI 0.47-0.98; p = 0.04).

CONCLUSION

PCR might not be related to the occurrence of postoperative complications in rectal cancer patients following nCRT. In addition, PCR might be associated with a lower risk of surgical-site infection.

Occupational burnout among clinical research associates in China

BACKGROUND

Clinical research associates (CRAs) play an important role in pharmaceutical research and development. Despite growing concern about occupational burnout among CRAs in China, little is known about this topic.

AIMS

We evaluated the factors associated with occupational burnout among CRAs in China and assessed the extent and nature of this syndrome in order to develop effective countermeasures.

METHODS

In October 2020, we collected data from a convenience sample of 438 CRAs from 26 major cities across China using a custom-designed questionnaire. We evaluated their psychopathological status and degree of occupational burnout based on the Maslach Burnout Inventory. Factors associated with burnout were identified using the Wilcoxon rank test, Kruskal-Wallis test, Spearman's rank correlation and multivariable ordinal logistic regression.

RESULTS

Of the 438 CRAs analyzed, 82% showed signs of occupational burnout, with a large proportion experiencing moderate burnout (50%). Burnout in Chinese CRAs manifested as emotional exhaustion (77%), depersonalization (66%) and low sense of accomplishment (15%). The severity of burnout was significantly affected by mode of working (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.04-2.34), average number of working hours per week (OR 1.68, 95% CI 1.14-2.46), support provided by the hospital (OR 3.13, 95% CI 1.40-6.99) and likelihood of receiving a promotion (OR 4.05, 95% CI 1.34-12.22) (all P < 0.05).

CONCLUSIONS

The incidence of occupational burnout among CRAs in China is high. Companies and hospitals must take effective measures to establish support systems for CRAs in order to alleviate this situation and thereby ensure the quality of clinical trials.

Changed expression of microRNAs may predict postoperative atrial fibrillation in patients with cardiac surgery

OBJECTIVE

Changes of microRNAs (miRNAs) may contribute to the pathogenesis and progression of postoperative atrial fibrillation (POAF) in patients undergoing cardiac valve surgery. This study aimed to measure the expression levels of miRNAs in peripheral blood, as well as their target mRNAs, in POAF patients and normal controls (non-POAF), and to evaluate the potential of miRNAs as promising biomarkers to predict POAF.

PATIENTS AND METHODS

The expression of miRNAs in peripheral blood, including miR-27b, miR-133a, miR-328, miR-499 and their target mRNAs, was analyzed in 109 POAF patients and 96 non-POAF patients via quantitative real-time polymerase chain reaction (RT-PCR). We compared differences between the two groups and also analyzed the treat reaction to amiodarone.

RESULTS

All miRNAs in POAF patients were significantly highly expressed. Compared to non-POAF, the expression of miR-27b, miR-133a, miR-328, miR-499 increased in both groups of POAF patients, and miR-499 was the only upregulated miRNAs in the amiodarone - group versus amiodarone + group and non-POAF. Among the upregulated miRNAs, miR-499 expression significantly changed in amiodarone + and amiodarone - patients (p = 0.005). The ROC curve analysis revealed that miR-499 might be a potential therapeutic response biomarker. The miRNA-mRNA interactions revealed 10 mRNAs regulated by miR-27b, miR-133a, and miR- 499.

CONCLUSIONS

We found an expression on miR-133a, miR-27b, miR-328, and miR-499 was significantly different between these groups, with a high expression being observed in POAF patients compared to non-POAF patients. Further, the present results showed that miR-499 was significantly upregulated in amiodarone - patients, compared to non-POAF, and amiodarone + patients. This finding indicates that miR-499 may be a potential biomarker for predicting the occurrence of POAF after cardiac valve surgery and treat the reaction to amiodarone.