The Roles and Mechanisms of TRAT1 in the Progression of Non-Small Cell Lung Cancer

Objective T cell receptor-associated transmembrane adaptor 1(TRAT1)is one of the hub genes regulating T cell receptors(TCRs).Herein,the roles of TRAT1 in the prognosis and immune microenvironment of non-small cell lung cancer(NSCLC)were investigated.Methods The expression and prognosis values of TRAT1 in NSCLC,and the relationship between TRAT1 expression levels and cancer immune cell infiltration was identified via the TIMER,UALCAN,TISIDB,and other databases.The mechanism of TRAT1 in NSCLC was analyzed using gene set enrichment analysis(GSEA).Results The expression level of TRAT1 was decreased in NSCLC tissues.Low TRAT1 expression was associated with shorter overall survival of patients with NSCLC and was related to gender,smoking,and tumor grade.TRAT1 was involved in regulating immune response,TCR signaling pathway,PI3K/AKT,and other processes.TRAT1 expression levels were positively correlated with immune cell infiltration in NSCLC.Conclusion Down-regulation of TRAT1 expression was associated with an unfavorable prognosis and immune infiltration of NSCLC.

A Lazarus effect： A case report of Bupropion overdose mimicking brain death

Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG. Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts, Our patient ultimately made a full neurologic recovery a few days later. While there are two other cases in the literature of bupropion overdose resulting in EEG burst-suppression and loss of brainstem reflexes, we believe this is the only reported adult case complicated by cardiac arrest.

Evaluation of the Application Effect of "One Disease, One Product" Nursing Program in Improving Swallowing Function and ADL of Stroke Patients

[Objectives] To observe the effect of "One Disease, One Product" nursing program in improving swallowing function and activities of daily living (ADL) of stroke patients.[Methods] 240 patients with stroke complicated with dysphagia were divided into intervention group and control group according to the random number table method, with 120 cases in each group. The patients in the intervention group were treated with "One Disease, One Product" nursing program for standardized process nursing, and the control group was treated with routine nursing for stroke. Three weeks later, the swallowing function of the two groups of patients was evaluated by water swallowing test. At the same time, Barthel life index was used to evaluate patients activities of daily living (ADL) before nursing, after 3 weeks and after 3 months of nursing.[Results] After 3 weeks, the proportion of stroke patients with normal swallowing function in both groups increased compared with before, and the increase was more obvious in the intervention group. The difference in the proportion of stroke patients with normal swallowing function between the intervention group and the control group was statistically significant. The BI index scores after 3 weeks or at the follow-up three months later showed that compared with the same group before care, the BI index scores of patients in both groups increased significantly compared with before, but the increase was even greater in the intervention group, close to normal.[Conclusions] The "One Disease, One Product" nursing program can significantly improve the swallowing function of stroke patients, and can improve the near and long-term activities of daily living of patients, thus creating a high-quality nursing service brand.

Evaluation of neuro-intensive care unit performance in China： predicting outcomes of Simplified Acute Physiology Score II or Glasgow Coma Scale

Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.

Migraine in physicians and final year medical students:A crosssectional insight into prevalence,self-awareness,and knowledge from Pakistan

BACKGROUND Despite its high prevalence,migraine remains underdiagnosed worldwide.A significant reason is the knowledge gap in physicians regarding diagnostic criteria,clinical features,and other clinical aspects of migraine.AIM To measure the knowledge deficit in physicians and medical students and to assess the prevalence of migraine in the same population.METHODS An online questionnaire was developed and distributed among physicians and final year medical students on duty in various medical and surgical specialties of Allied and DHQ Hospitals,Faisalabad,between October 2018 and October 2019.Inclusion criteria were public practicing physicians who experience headaches,while those who never experienced headaches were excluded.Different questions assessed respondents on their knowledge of triggers,diagnosis,management,and prophylaxis of the migraine headache.They were asked to diagnose themselves using embedded ICHD-3 diagnostic criteria for different types of migraine.Graphs,tables,and figures were made using Microsoft Office 2016 and Microsoft Visio,and data analysis was done in R Studio 1.4.RESULTS We had 213 respondents and 175 fulfilled inclusion criteria,with 99(52%),58(30%)and 12(6.3%)belonging to specialties of medicine,surgery,and others,respectively.Both genders were symmetrically represented(88 male and 87 female).Fifty-two(24.4%)of our 213 respondents were diagnosed with migraine,with 26(50%)being aware of it.Females had higher prevalence among study participants(n=28,32.2%)compared to males(n=20,22.7%,P=0.19).A majority(62%)of subjects never consulted any doctor for their headache.Similarly,a majority(62%)either never heard or did not remember the diagnostic criteria of migraine.Around 38%falsely believed that having any type of aura is essential for diagnosing migraine.The consultation rate was 37%(n=65),and migraineurs were significantly more likely to have consulted a doctor,and a neurologist in particular(P<0.001).Consulters and migraineurs fared better in the knowledge of diagnostic aspects of the disease than their counterparts.There was no significant difference in other knowledge aspects between consulters versus non-consulters and migraineurs versus nonmigraineurs.CONCLUSION Critical knowledge gaps exist between physicians and medical students,potentially contributing to misdiagnosis and mismanagement of migraine.

Diagnosis of brain death： confirmatory tests after clinical test

Background The brain death confirmation tests occupy a different position in each country＇s diagnostic criteria （or guideline）; the choices of tests are also different.China brain death criteria include clinical judgment and confirmation tests.This study aimed to confirm the preferred confirmatory test and complementary confirmatory tests.Methods We did a clinical brain death determination on deep coma patients,and then divided them into brain death group and non-brain death group.According to the Chinese standards for determining brain death,both the groups accepted confirmatory tests including electroencephalograph （EEG）,somatosensory evoked potentials （SEP）,and transcranial Doppler （TCD）.The sensitivity,specificity,false positive rate,and false negative rate were calculated to evaluate the accuracy of the confirmatory tests.Results Among the 131 cases of patients,103 patients met the clinical criteria of brain death.Respiratory arrest provocation test was performed on 44 cases and 32 cases （73％） successfully completed and confirmed that they have no spontaneous breathing.Of the three confirmation tests,EEG had the highest completion rate （98％） and good sensitivity （83％） and specificity （97％）; TCD had followed completion rate （54％） and not good sensitivity （73％） and specificity （75％）; SEP had the lowest completion rate （49％）,good sensitivity （100％）,and not good specificity （78％）.After the combination of SEP or TCD with EEG,the specificity can increase to 100％.Conclusions The completion rate of respiratory arrest provocation test remains a problem in the clinical diagnosis of brain death.If the test cannot be completed,whether to increase a confirmatory test is debatable.SEP had an ideal sensitivity,and the specificity will reach 100％ after combining with TCD or EEG.When a confirmed test was uncertain,we suggest increasing another confirmatory test.

Study of Simplified Coma Scales： Acute Stroke Patients with Tracheal Intubation

Background： Whether the Glasgow Coma Scale （GCS） can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component （GCS-M）/Simplified Motor Score （SMS） to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients. Methods： A retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit （NCU）. Outcomes were death and unfavorable prognosis （modified Rankin Scale： 5-6） at NCU discharge. The receiver operating characteristic （ROC） curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves （AUCs） was performed using the Z-test.Results： Of 106 patients included in the study, 41 （38.7%） patients died, and 69 （65.1%） patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale＇s predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h （0.721 vs. 0.717, Z = 0.135, P = 0.893） and 72 h （0.730 vs. 0.765, Z = 1.887, P = 0.060）, in predicting poor prognosis at 0 h （0.827 vs. 0.819, Z = 0.395, P = 0.693）, 24 h （0.771 vs. 0.760, Z = 0.944, P = 0.345）, 48 h （0.732 vs. 0.741, Z= 0.593, P= 0.590）, and 72 h （0.775 vs. 0.780, Z= 0.302, P= 0.763）. AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death （0.964 vs. 0.964, P = 1.000） and poor prognosis （ 1.000 vs. 1.000, P = 1.000） for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M （〈0.700）, in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h （P 〉 0.05）. The SMS AUCs （〈0.700） in predicting outcomes were poor. Conclusions： The GCS-M approaches the same test performance as the GCS in assessing the prognosis ofintubatcd acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.

Early Hypothermia for Refractory Status Epilepticus

INTRODUCTION Currently, the recommended therapy to control refractory status epilepticus （RSE） is intravenous （IV） anesthetics, such as midazolam, propofol, barbiturates, and so on. However, 15%-26% of RSE cases still cannot be terminated.