Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy:A case report

BACKGROUND Refractory secondary hyperparathyroidism(SHPT)is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification.Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias,including atrioventricular block.This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block(CAVB),which was eventually reversed to a first-degree atrioventricular block.CASE SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy.She developed SHPT,and an electrocardiogram revealed a first-degree atrioventricular block.Then,she underwent parathyroidectomy(PTX)with autotransplantation.Unfortunately,a few years later,she developed SHPT again,and an electrocardiogram revealed a CAVB.A few years after the second PTX surgery,the calcification of the left atrium and left ventricle improved,and her CAVB was reversed.CONCLUSION This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage.Following parathyroid surgery,calcification of the cardiac conduction system improved,leading to reversal of the atrioventricular block.It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

Duodenal-jejunal bypass improves hypothalamic oxidative stress and inflammation in diabetic rats via glucagon-like peptide 1-mediated Nrf2/HO-1 signaling

BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.

Is there a place for endoscopic management in postcholecystectomy iatrogenic bile duct injuries?

In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.

Successful treatment of breast metastasis from primary transverse colon cancer:A case report

BACKGROUND The incidence of colon cancer is increasing worldwide.Treatments for colon cancer include surgery and surgery combined with chemotherapy and radiotherapy,but the median survival rate is still poor.Colon cancer most commonly metastasizes to the lymph nodes,lungs,liver,peritoneum,and brain,but breast metastasis is rare.There is no agreement on its treatment.CASE SUMMARY A 23-year-old woman was admitted to our hospital for further treatment with a history of acute abdominal pain,nausea,and vomiting.Her physical examination and computed tomography scan revealed an abdominal tumor.Transverse colectomy was successfully performed.Histopathological examination revealed that the tumor was a mucosecretory adenocarcinoma with signet ring cells.The patient inadvertently found a mass in the outer upper quadrant of the right breast after four cycles of XELOX chemotherapy[oxaliplatin 130 mg/m^(2),d1,intravenous(iv)drip for 2 h;capecitabine 1000 mg/m^(2),po,bid,d1–d14].After discussion with the patient,we performed a lumpectomy and frozen biopsy.The latter revealed that the breast tumor was intestinal metastasis.Genetic testing showed wild-type RAS and BRAF.So we replaced the original chemotherapy with FOLFIRI[irinotecan 180 mg/m^(2),d1,iv drip for 3–90 min;leucovorin 400 mg/m^(2),d1,iv drip for 2 h;5-fluorouracil(5-FU)400 mg/m^(2),d1 and 5-FU 1200 mg/(m^(2)d)×2 d,continuous iv drip for 46–48 h]+cetuximab(500 mg/m^(2),d1,iv drip for 2 h).Serum levels of tumor markers returned to normal after several treatment cycles,and there was no evidence of tumor recurrence or metastasis.CONCLUSION Breast metastasis from colon cancer is rare.Radical breast surgery should be avoided unless needed for palliation.Chemotherapy combined with targeted therapy should be the first choice.

Simultaneously metastatic cholangiocarcinoma and small intestine cancer from breast cancer misdiagnosed as primary cholangiocarcinoma:A case report

BACKGROUND Cholangiocarcinoma and small intestine cancer are common clinical malignancies,but metastatic cholangiocarcinoma and small intestine cancer are rare,especially simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer.Since the clinical presentation of metastatic cholangiocarcinoma and small intestine cancer does not differ from primary tumor,it may lead to misdiagnosis preoperatively.CASE SUMMARY A 66-year-old woman was admitted to our hospital for further treatment due to abdominal pain and jaundice.Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed an occupying lesion of the bile duct,considering a high possibility of primary bile duct tumor.Therefore,we performed a radical bile duct cancer surgery and cholecystectomy,and multiple tumors in the small intestine were found and removed during the surgery process.Postoperative pathology showed metastatic bile duct cancer and small intestine cancer from tumors in other parts.The patient underwent a right total mastectomy and axillary lymph node dissection because of right breast cancer 2 years ago.Combining with the immunohistochemical results,the patient was finally diagnosed as metastatic cholangiocarcinoma and metastatic small intestine cancer from breast cancer.Postoperatively,the patient received four cycles of chemotherapy and targeted therapy with docetaxel,capecitabine and trastuzumab.Unfortunately,the patient eventually died from tumor progression,thoracoabdominal infection,and sepsis 5 mo after surgery.CONCLUSION Simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer are rare and the prognosis is extremely poor.Improving preoperative diagnostic accuracy is beneficial to avoid excessive surgical treatment.Treatment should be aimed at relieving biliary obstruction and abdominal pain,and then supplemented with chemotherapy and targeted therapy to control tumor progression and prolong the patient’s life.

Trends of Oral Cancer Mortality in China from 1990 to 2019 and a 15-Year Predictive Analysis Based on a Bayesian Age-Period-Cohort Model

Oral cancer is the most common malignant tumor of the head and neck.It is characterized by high rates of recurrence and distant metastasis and usually has a poor prognosis.Despite advances in cancer diagnosis and treatment,the overall 5-year survival rate for oral cancer remains within40%-50%[1].

Overexpression of kallikrein gene 10 is a biomarker for predicting poor prognosis in gastric cancer

AIM:To analyze the expression of kallikrein gene 10(KLK10)in gastric cancer and to determine whether KLK10 has independent prognostic value in gastric cancer.METHODS:We studied KLK10 expression in 80 histologically confirmed gastric cancer samples using realtime quantitative reverse transcription-PCR and hK10expression using immunohistochemistry.Correlations with clinicopathological variables(lymph node metastasis,depth of invasion and histology)and with outcomes(disease-free survival and overall survival)during a median follow-up period of 31 mo were assessed.Gastric cancer tissues were then classified as KLK10 positive or negative.RESULTS:KLK10 was found to be highly expressed in 57/80(70%)of gastric cancer samples,while its expression was very low in normal gastric tissues.Positive relationships between KLK10 expression and lymph node metastasis(P=0.048),depth of invasion(P=0.034)and histology(P=0.015)were observed.Univariate survival analysis revealed that gastric cancer patients with positive KLK10 expression had an increased risk for relapse/metastasis and death(P=0.005 and0.002,respectively).Cox multivariate analysis indicated that KLK10 was an independent prognostic indicator of disease-free survival and overall survival in patients with gastric cancer.CONCLUSION:KLK10 expression is an independent biomarker of unfavorable prognosis in patients with gastric cancer.

Promotion of Sema4D expression by tumor-associated macrophages: Significance in gastric carcinoma

AIM To study the role of semaphorin 4 D(Sema4 D) expression promoted by tumor-associated macrophages(TAMs) in gastric carcinoma cells and its clinical significance in the invasion and metastasis of gastric carcinoma.METHODS CD68 and Sema4 D expression was analyzed in gastric carcinoma and adjacent normal tissues from 290 patients using the immunohistochemical streptavidinperoxidase method, and their relationships with clinicopathological features were evaluated. Human M2 macrophages were induced in vitro and co-cultured in non-contact with gastric carcinoma SGC-7901 cells. Changes in the secretory Sema4 D level in the SGC-7901 cell supernatant were measured using an enzymelinked immunosorbent assay. The effects of TAMs on SGC-7901 cell invasion and migration were assessed with invasion and migration assays, respectively.RESULTS CD68 and Sema4 D protein expression was significantly higher in gastric carcinoma tissues than in adjacent normal tissues(71.7% vs 33.8% and 74.5% vs 42.8%, respectively; P < 0.01). CD68 and Sema4 D protein expression was significantly associated with histological differentiation, TNM stage, and lymph node metastasis(P < 0.05), and their expression levels were positively correlated with one another(r = 0.467, P < 0.01). In the in vitro experiment, secretory Sema4 D protein expression was significantly increased in the supernatant of SGC-7901 cells co-cultured with TAMs compared with the blank control(1224.13 ± 29.43 vs 637.15 ± 33.84, P < 0.01). Cell invasion and metastasis were enhanced in the Transwell invasion and migration assays(P < 0.01).CONCLUSION TAMs promote the invasion and metastasis of gastric carcinoma cells possibly through upregulated secretory Sema4 D protein expression. Combined detection of TAM markers, CD68 and Sema4 D, in gastric carcinoma tissue shows potential to predict the trend of gastric carcinoma progression.

Bridging peripheral nerves using a deacetyl chitin conduit combined with short-term electrical stimulation

Previous studies have demonstrated that deacetyl chitin conduit nerve bridging or electrical stimulation can effectively promote the regeneration of the injured peripheral nerve. We hypoth-esized that the combination of these two approaches could result in enhanced regeneration. Rats with right sciatic nerve injury were subjected to deacetyl chitin conduit bridging combined with electrical stimulation （0.1 ms, 3 V, 20 Hz, for 1 hour）. At 6 and 12 weeks after treatment, nerve conduction velocity, myelinated axon number, ifber diameter, axon diameter and the thickness of the myelin sheath in the stimulation group were better than in the non-stimulation group. The results indicate that deacetyl chitin conduit bridging combined with temporary electrical stimu-lation can promote peripheral nerve repair.

HPV Infection among Uygur Women in a Rural Area of Hetian Prefecture,Xinjiang Uygur Autonomous Region, China

It is not clear how HPV infection is prevalent among Uygur women in Xinjiang Uygur Autonomous Region, China and whether the distribution of HPV infection is related with cervical intraepithelial neoplasia （CIN） incidence among them. A study including 883 Uygur women were conducted from 2006 to 2007 in Hetian Prefecture, Xinjiang Uygur Autonomous Region, China.

Expression of annexin A5 in serum and tumor tissue of patients with colon cancer and its clinical significance

AIM To investigate the expression of annexin A5 in serum and tumor tissue of patients with colon cancer and to analyze its clinical significance.METHODS Ninety-three patients with colon cancer treated at our hospital between February 2013 and March 2016 were included in an observation group, and 40 healthy individuals were included in a control group. Enzyme-linked immunosorbent assay was performed to determine the serum level of annexin A5, while immunohistochemistry was performed to determine the expression of annexin A5 in cancer tissues.RESULTS The serum level of annexin A5 was 0.184 ± 0.043 ng/m L in the observation group, which was significantly higher than that in the control group(P < 0.05). Annexin A5 expression was detected in 79.31% of the patients with lymph node metastasis, which was significantly higher than that in patients without lymph node metastasis(P < 0.05). Moreover, annexin A5 expression was detected in 86.96% of the patients with stage Ⅲ to Ⅳ disease, which was significantly higher than that in patients with stage Ⅰ to Ⅱ disease(P < 0.05). The serum level of annexin A5 was 0.215 ± 0.044 ng/m L in patients whose tumors were positive for annexin A5 expression, which was significantly higher than that in patients whose tumors were negative for annexin A5 expression(P < 0.05). The serum level of annexin A5 was correlated with annexin A5 expression in colon cancer tissues(r= 0.312, P < 0.05). When a cutoff value of > 0.148 ng/m L for serum level of annexin A5 was used in the diagnosis of colon cancer, the sensitivity was 83.90%, and the specificity was 57.50%.CONCLUSION For patients with colon cancer, annexin A5 expression in cancer tissues is related to lymph node metastasis and tumor grade. Serum level of annexin A5 is related to annexin A5 expression in cancer tissues and is of diagnostic relevance.

Ultrastructural localization of glutathione S-transferase-pi in human colorectal cancer cells

INTRODUCTION Placental form glutathione S-transferase(GST-pi)isa group of isoenzymes with protein combiningability.Since the reports showing that GST-pi wassignificantly increased in proliferative hepaticnodule induced by chemical carcinogen and in welldifferentiated carcinoma,more studies haveshown that GST-pi expressed highly inneoplasm,and could be regarded as a

Mannose-binding lectin 2 rs11003123 polymorphism is associated with the development of hepatocellular carcinoma in patients with hepatitis B-related cirrhosis in the Chinese population

BACKGROUND： Mannose-binding lectin 2 （MBL2） plays a key role in the host immune response, but whether it is associ- ated with hepatocellular carcinoma （HCC） is not dear. The present study aimed to identify the association between MBL2 gene polymorphisms and HCC in patients with hepatitis B virus （I-IBV）-related cirrhosis in the Chinese population.

Comparison of commonly used retrograde tracers in rat spinal motor neurons

The purpose of this study was to investigate the effect of four fluorescent dyes, True Blue（TB）, Fluoro-Gold（FG）, Fluoro-Ruby（FR）, and 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate（Di I）, in retrograde tracing of rat spinal motor neurons. We transected the muscle branch of the rat femoral nerve and applied each tracer to the proximal stump in single labeling experiments, or combinations of tracers（FG-Di I and TB-Di I） in double labeling experiments. In the single labeling experiments, significantly fewer labeled motor neurons were observed after FR labeling than after TB, FG, or Di I, 3 days after tracer application. By 1 week, there were no significant differences in the number of labeled neurons between the four groups. In the double-labeling experiment, the number of double-labeled neurons in the FG-Di I group was not significantly different from that in the TB-Di I group 1 week after tracer application. Our findings indicate that TB, FG, and Di I have similar labeling efficacies in the retrograde labeling of spinal motor neurons in the rat femoral nerve when used alone. Furthermore, combinations of Di I and TB or FG are similarly effective. Therefore, of the dyes studied, TB, FG and Di I, and combinations of Di I with TB or FG, are the most suitable for retrograde labeling studies of motor neurons in the rat femoral nerve.

Giant struma ovarii with pseudo-Meigs’syndrome and raised cancer antigen-125 levels:A case report

BACKGROUND Struma ovarii is a type of monodermal mature teratoma composed entirely or mainly of thyroid tissue,accounting for 1%to 3%of all ovarian teratomas and 0.3%to 1.0%of all ovarian tumors.Of which,struma ovarii with ascites and pleural effusion,called pseudo-Meigs’syndrome and raised cancer antigen-125levels(CA 125)is even rarer.CASE SUMMARY This paper reports the diagnosis and treatment of a patient of struma ovarii with pseudo-Meigs’syndrome,presenting with the clinical features of ovarian carcinoma:Complex pelvic mass,gross ascites,right pleural effusion and markedly elevated serum CA 125 levels.During the operation,a cystic-solid mass about 20cm×10 cm×5 cm in the right adnexa and a solid mass with the size of 3 cm×2cm×0.1 cm in the left ovary were observed.She underwent right adnexectomy and resection of the left ovarian mass and histopathology revealed a mature leftsided ovarian teratoma and struma ovarii of right adnexal mass.During 1-year follow-up,the patient recovered well,tumor markers and other indicators returned to normal.CONCLUSION The diagnosis and treatment process of this case suggests that the clinical symptoms of struma ovarii with pseudo-Meigs’syndrome are lack specificity,which is easily misdiagnosed.Clinicians should improve the understanding of this disease,enhance the awareness of early screening,and improve the level of diagnosis and treatment.

Mesenchymal stem cells and mesenchymal stem cell-derived extracellular vesicles:Potential roles in rheumatic diseases

BACKGROUND Mesenchymal stem cells(MSCs)have been widely investigated in rheumatic disease due to their immunomodulatory and regenerative properties.Recently,mounting studies have implicated the therapeutic potency of MSCs mostly due to the bioactive factors they produce.Extracellular vesicles(EVs)derived from MSCs have been identified as a promising cell-free therapy due to low immunogenicity.Rheumatic disease,primarily including rheumatoid arthritis and osteoarthritis,is a group of diseases in which immune dysregulation and chronic progressive inflammation lead to irreversible joint damage.Targeting MSCs and MSC-derived EVs may be a more effective and promising therapeutic strategy for rheumatic diseases.AIM To evaluate the potential therapeutic effectiveness of MSCs and EVs generated from MSCs in rheumatic diseases.METHODS PubMed was searched for the relevant literature using corresponding search terms alone or in combination.Papers published in English language from January 1999 to February 2020 were considered.Preliminary screening of papers concerning analysis of"immunomodulatory function"or"regenerative function"by scrutinizing the titles and abstracts of the literature,excluded the papers not related to the subject of the article.Some other related studies were obtained by manually retrieving the reference lists of papers that comply with the selection criteria,and these studies were screened to meet the final selection and exclusion criteria.RESULTS Eighty-six papers were ultimately selected for analysis.After analysis of the literature,it was found that both MSCs and EVs generated from MSCs have great potential in multiple rheumatic diseases,such as rheumatoid arthritis and osteoarthritis,in repair and regeneration of tissues,inhibition of inflammatory response,and regulation of body immunity via promoting chondrogenesis,regulating innate and adaptive immune cells,and regulating the secretion of inflammatory factors.But EVs from MSCs exhibit much more advantages over MSCs,which may represent another promising cell-free restorative strategy.Targeting MSCs and MSC-derived EVs may be a more efficient treatment for patients with rheumatic diseases.CONCLUSION The enormous potential of MSCs and EVs from MSCs in immunomodulation and tissue regeneration offers a new idea for the treatment of rheumatism.However,more in-depth exploration is needed before their clinical application.

Routine clinical administration of 4-week alverine citrate and simeticone combination relief global IBS symptoms

Introduction: The primary treatment aim for irritable bowel syndrome (IBS) is to relieve overall symptoms which can significantly impair the patient’s quality of life (QOL);however, it generally requires a high pill burden that may be improved by administration of combinatorial formulations. Thus, the effectiveness of alverine citrate and simeticone combination (ACS) for global symptom relief for IBS was investigated in this non-interventional study. Patients and Methods: ROME III IBS patients (n = 640;52.3% male: mean age: 43.6 ± 12.5 years) with abdominal pain and discomfort ≥60 of 0-100 visual analogue scale (VAS) were included in a prospective, multicenter, non-interventional study at 26 Chinese sites from December 2010 to January 2012. Patients received alverine citrate (60 mg) with simeticone (300 mg) (ACS) 3× daily for 4 weeks. Pain/discomfort and bloating/distension were assessed by VAS. Global symptoms and QOL were assessed by 7-point and 5-point Likert scales, respectively. Post-treatment bowel function was assessed by Bristol Stool Form Scale (BSFS) and treatment-related adverse events (AEs) were recorded. Results: Of 640 patients, 540 (84.4%) completed the study, and 100 (15.6%) withdrew. In total, 87.5% reported bloating at baseline. After 4-week ACS treatment, 89.1% reported global symptom improvement. Furthermore, 4-week ACS treatment reduced pain and bloated VAS scores significantly from 78.4 ± 9.9 to 32.1 ± 21.0 and from 63.2 ± 27.2 to 22.6 ± 20.9, respectively (both p < 0.001), decreased diarrhea or constipation occurrence from 67.2% to 10.2% (p < 0.001), and reduced IBS impact on QOL with only 2 treatment-related AEs. Conclusion: Routine clinical administration of ACS for IBS over a 4-week period provides effective relief of IBS symptoms and improves QOL in IBS patients.

Protection of Salvianolic Acid B for Human Endothelial Cells Against Hydrogen Peroxide-Induced Oxidative Damage

Salvianolic acid B(Sal B) is an active component of traditional Chinese medicine Salvia miltiorrhiza and is used to treat vascular diseases. To better understand its mechanism, the antioxidant capacities of Sal B was evaluated with human endothelial cells under oxidative stress. Human endothelial cells were pretreated with Sal B for 12 h followed by hydrogen peroxide for another 12 h. Production of reactive oxygen species (ROS), activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX), and concentration of glu-tathione were measured. Protective effect of Sal B on the endothelial cells from hydrogen peroxide-induced damage was observed, and ROS production in the cells was found significantly inhibited. Sal B remarkably enhanced the activities of antioxidant enzymes SOD, CAT and GPX. Furthermore, Sal B up-regulated the intracellular glu-tathione concentration. The results indicate that Sal B protected endothelial cells from oxidative stress by improving the redox status of the cells through enhancing the antioxidant enzyme activities and increasing the reductive glu-tathione concentration after the oxidative challenge.

Validation of Symptom Dimensions and Sub-Type Responses in Cognitive Behavioral Therapy in Obsessive Compulsive Disorder: A Systemic Review and Meta-Analysis

Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition without a conclusivesubtype dimension. This study will focus on the meta-analysis of the clinical responses of OCD subtypes to cognitivebehavioral therapy (CBT), which might clarify this issue. Methods: We performed a systematic search and ameta-analysis for the studies of OCD subtypes and the response to CBT in PubMed, ScienceDirect, Embase, Webof Science, and Scopus databases. The selective criteria were the OCD without significant medical or psychiatricco-morbidities and pre-and post-treatment changes in scores of OCD dimension. In addition, different subtypesof OCD in symptom dimensions, such as symmetry, contamination, unacceptable thoughts, and hoarding, werecompared to find the most significant subtype using the treatment response parameters by CBT. After limitedselection, four studies and 479 OCD subjects were enrolled. The meta-analysis was performed by Review Manager5.4, and only significant results were reported. Results: Among the OCD subtypes, the meta-analysis favors thehoarding subtype with poorer responses to CBT than symmetry, contamination, and unacceptable thoughts.The meta-analysis results were negative mean differences, significant tests for overall effect, and limited heterogeneitiesin the random effects model. In addition, the results were more significant when the hoarding subtypewas compared with non-hoarding subtypes. Conclusion: The hoarding subtype might be the most significantrepresentative subtype of OCD symptom dimension under the impression of unfavorable clinical response toCBT. However, future studies with more treatment parameters will be warranted to confirm this finding.