bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential actions of indomethacin: clinical relevance in headache
Authors: Summ Oliver , Andreou Anna P. , Akerman Simon , Holland Philip R. , Hoffmann Jan , Goadsby Peter J.
Published: August 2020

Nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, are used routinely in the treatment of primary headache disorders. Indomethacin is unique in its use in the diagnosis and treatment of hemicrania continua and paroxysmal hemicrania. The mechanism of this specific action is not fully understood, although an interaction with nitric oxide (NO) signaling pathways has been suggested. Trigeminovascular neurons were activated by dural electrical stimulation, systemic administration of an NO donor, or local microiontophoresis of L-glutamate. Using electrophysiological techniques, we subsequently recorded the activation of trigeminovascular neurons and their responses to intravenous indomethacin, naproxen, and ibuprofen. Administration of indomethacin (5 mg·kg−1), ibuprofen (30 mg·kg−1), or naproxen (30 mg·kg−1) inhibited dural-evoked firing within the trigeminocervical complex with different temporal profiles. Similarly, both indomethacin and naproxen inhibited L-glutamate-evoked cell firing suggesting a common action. By contrast, only indomethacin was able to inhibit NO-induced firing. The differences in profile of effect of indomethacin may be fundamental to its ability to treat paroxysmal hemicrania and hemicrania continua. The data implicate NO-related signaling as a potential therapeutic approach to these disorders.
Determinants of High-Sodium Food Intake Among Indonesian Patients With Hypertension
Authors: Wicaksana Anggi Lukman , Yen Miaofen , Wang Shan-Tair , Fetzer Susan Jane
Published: August 2020

Background

Sodium restriction is difficult for most individuals with hypertension. Intention to limit sodium intake predicts behavior. Information on the determinants of intention to restrict sodium intake is limited.

Objectives

The aims of this study were to identify (1) determinants of intention to restrict high-sodium food intake and (2) sources of sodium consumed by patients with hypertension in Indonesia.

Methods

A cross-sectional study was conducted among adult patients with hypertension (n = 206) attending cardiac clinics. A researcher-developed and tested, self-administered questionnaire that included questions about sodium restriction and a high-sodium food inventory was distributed. The quantile regression method was used to identify determinants of intention to restrict dietary sodium.

Results

The mean age of the patients with hypertension was 59 ± 10 years, and more than three-fourths were obese (n = 162, 78%). The determinants of intention to limit sodium intake included gender (β = 0.737, P = .036), attitude (β = −0.141, P = .050), and subjective norm (β = −0.283, P = .005). Men reported higher sodium consumption, while attitudes and subjective norm were negatively correlated with sodium intake. These determinants predicted 13.2% of the variance in intention to restrict dietary sodium. Subjects reported frequently consuming snacks (n = 82, 39.7%) and seasoning condiments (n = 65, 31.6%).

Conclusions

High-sodium snacks and condiments added while cooking were frequently consumed among patients with hypertension in Indonesia. Understanding the factors associated with intention to follow a low-sodium diet will assist nurses to design effective interventions that promote adherence to the low-sodium diet among those with hypertension.
Major Adverse Cardiovascular Events in Antidepressant Users Within Patients With Ischemic Heart Diseases
Authors: Kim Jae Hyun , Song Yun-Kyoung , Jang Ha Young , Shin Ju-Young , Lee Hae-Young , Ahn Yong Min , Oh Jung Mi , Kim In-Wha
Published: August 2020

Background

To evaluate the effect of antidepressants on the development of major adverse cardiovascular events (MACEs) in patients with ischemic heart disease (IHD), we analyzed the association between antidepressant use and the risk of MACE development.

Methods

Patients with depression and a history of IHD between 2008 and 2012 were identified by using the National Health Insurance Service database. A cohort was followed up for the development of MACE until the end of 2015. Hazard ratios (HRs) for myocardial infarction, stroke, and cardiovascular death were estimated by Cox proportional hazard regression in a propensity score–matched cohort.

Results

Over a median 4.2 years of follow-up, 2943 MACE occurred in 18,981 antidepressant users. Use of antidepressants was not associated with the incidence of MACE when compared with antidepressant nonusers (adjusted HR, 1.00; 95% confidence interval, 0.95–1.05). Among the analyses according to different classes of antidepressants, the increased risk of stroke was only observed in the subgroup of selective serotonin reuptake inhibitor (SSRI) users. Dose-response findings reported greater risk in those with higher doses of use (SSRIs with ≥1.0 defined daily dose; adjusted HR, 1.14; 95% confidence interval, 1.06–1.23), whereas duration response does not support association.

Conclusions

Compared with antidepressant nonusers, use of antidepressants was not associated with occurrence of MACEs in patients with depression and IHD. Although the overall effect of antidepressants on the risk of MACE was neutral, careful monitoring of MACE development is recommended in high-dose SSRI users.
Efficacy and safety of acupuncture for urinary retention
Authors: Zhao Qinyu , Song Bao , Chen Shenshen , Zhu Yongzheng , Jia Hongling , Liu Shenyang
Published: August 2020

Background:

Many postoperative patients and males suffer urinary retention (UR) symptom, which directly affects their quality of life. Acupuncture is widely used by Traditional Chinese Medicine doctors to treat various postoperative urinary retention and elderly male urinary retention patients. However, acupuncture treatment of urinary retention symptoms lacks relevant multi-center clinical studies and lacks a more comprehensive meta-analysis report, which contradicts clinical practice. To confirm the safety and efficacy of acupuncture treatment of urinary retention caused by various reasons requires more comprehensive and strong evidence-based medical evidence.

Methods:

Databases including CNKI, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, EBSCO were retrieved for relevant literature, with the retrieval deadline being June 23, 2020. The 2 conducted independent reading of the retrieved literature and removed the duplications, and then used the Cochrane Handbook to score the randomized controlled trials (RCTs). Only when the score is greater than 5 points can they be included. Then extract the basic information of the included literature, post-voided residual urine (PVR), maximal cystometric capacity (MCC), maximal flow rate (MFR), bladder compliance (BC), adverse events (AE), and effective rate data, and make a literature feature table. The methodological quality was evaluated with the “Risk of Bias” tool, and the meta-analysis was performed by using the RevMan 5.3.5 software. Use Stata 15 for regression analysis to find the source of heterogeneity, and try to resolve it using subgroup analysis.

Results:

The analysis of PVR, MCC, MFR, BC, AE and effective rate data can provide high-quality evidence for high-quality synthesis and/or descriptive analysis of the effectiveness and safety of acupuncture treatment of various causes of urinary retention.

Conclusion:

This study can provide more comprehensive evidence to prove whether acupuncture is effective and safe for patients with UR.

Registration:

The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119238.
Using the bootstrapping method to verify whether hospital physicians have different h-indexes regarding individual research achievement
Authors: Kung Sheng-Chun , Chien Tsair-Wei , Yeh Yu-Tsen , Lin Jui-Chung John , Chou Willy
Published: August 2020

Background:

Individual researchers’ achievements (IRA) are determined by both personal publications and article citations such as Author Impact Factor, h-index, and x-index. Due to those indicators not truly supporting a normal distribution, the traditional t-test and Analysis of variance are not allowed for RA comparison in groups. The objective of this study is to use the bootstrapping method to verify whether hospital physicians have different h-indexes.

Methods:

We downloaded 63,266 journal articles with their corresponding citations for 2128 researchers from a Taiwan university website on December 10, 2019. Their IRAs were assessed using the bibliometric h-index. A pyramid plot was used to compare the h-index patterns between institutes. The x-index and the Kano model were found to be complemental to the h-index for identifying the group IRA characteristics and rankings, including colleges and departments in the university study, the School of Medicine, and the Affiliated Hospital. The bootstrapping method was applied with an estimated 95% confidence interval (CI) to distinguish the differences in physicians between the Internal Medicine and Surgery departments. The stronger-than-the-next coefficient (SC) for the highest represents the RA strength.

Results:

The highest h-indices were found in the College of Engineering, School of Medicine, and the Department of Internal Medicine in groups of colleges (SC = 0.71), all departments (SC = 0.83), the School of Medicine (SC = 0.74), and the Affiliated Hospital (SC = 0.56), respectively. No difference in h-index for hospital physicians was found between departments in Internal Medicine (Mean = 2.14, 95% CI = 1.02,3.26) and Surgery (mean = 2.5, 95%CI = 1.48, 3.52).

Conclusions:

The x-index and the Kano models can complement the h-index for identifying group IRA characteristics. The bootstrapping method allows estimation of the sampling distribution for almost any statistic using random sampling methods and gains measures of accuracy (as defined by 95% CI). The finding of no difference in h-index for hospital physicians between departments in Internal Medicine and Surgery requires further investigation in the future.
A randomized controlled trial for gualou danshen granules in the treatment of unstable angina pectoris patients with phlegm-blood stasis syndrome
Authors: Guo Jianbo , Dai Shuang , Ding Yukun , He Haoqiang , Zhang Hui , Dan Wenchao , Qin Kun , Wang Hui , Li Anqi , Meng Peipei , Li Shangjin , He Qingyong
Published: August 2020

Introduction:

Unstable angina pectoris is an acute exacerbation secondary to coronary artery occlusion. In routine clinical treatment, patients with unstable angina pectoris are prone to recurrence or aggravation of symptoms. Based on the traditional Chinese medicine (TCM) theory, phlegm, and blood stasis are one of the main pathological factors of unstable angina pectoris. The treatment of unstable angina pectoris with phlegm-blood stasis syndrome by Gualou Danshen granules (GLDS) has been the focus of many clinical trials. However, there is no evidence to prove the safety or clinical efficacy of GLDS.

Methods and analysis:

In this study, we will conduct a 4-week randomized, controlled feasibility study, with participants recruited from Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine. Sixty subjects are to be diagnosed as having phlegm-blood stasis syndrome and randomly divided into a treatment group (GLDS) and placebo group in a 1:1 ratio. Result measurements will include therapeutic indicators (Clinical Symptom Rating Scale, Phlegm-Blood Stasis Syndrome Scale, and Seattle Angina Questionnaire) and safety indicators (blood routine, urine routine, electrocardiogram, liver function, and kidney function). The clinical data management system (http://www.tcmcec.net/) will be used to collect and manage data. Quality control will be implemented according to good clinical practice.

Discussion:

Previous TCM clinical trials have investigated if adding GLDS to standard routine treatment can improve the therapeutic effect in patients with unstable angina pectoris. This study focuses on the safety and efficacy of GLDS on unstable angina pectoris of phlegm-blood stasis type, in order to obtain relevant clinical evidence.

Trial registration:

This study is approved by the Ethics Committee of Guang’anmen Hospital of the China Academy of Chinese Medical Sciences (no. 2019–187-KY-02) and is registered with chictr.org (registration number ChiCTR2000031780).
Association between hyperuricemia, gout, urate lowering therapy, and osteoarthritis
Authors: Zhu Junyu , Wang Yilun , Chen Yuhao , Li Xiaoxiao , Yang Zidan , Li Hui
Published: August 2020

Introduction:

Osteoarthritis (OA), a chronic and degenerative joint disease characterized by articular cartilage degeneration, sclerosis of subchondral bone, and osteophyte formation, is deemed a leading cause of activity limitation and disability among the elderly people. Serum uric acid (UA) is a terminal metabolite of purine compound, while hyperuricemia (HU) and UA crystals are recognized causes of gout. Several studies have investigated the correlations between HU, gout and OA, but the findings are inconclusive. We are also concerned whether the urate lowering therapy (ULT) can become a potential treatment for OA and intend to undertake this meta-analysis to clarify the related hypotheses.

Methods:

Systematic literature search will be conducted on PubMed, Embase, and Web of Science to identify relevant studies up to February 2020 using appropriate search strategies. All citations and abstracts retrieved from literature search will be assessed by two reviewers independently. The Newcastle-Ottawa Scale or the Cochrane risk of bias assessment tool will be used as appropriate to assess the quality and the risk of bias of the included studies. The heterogeneity and the publication bias of the studies will be investigated accordingly.

Results:

We propose to undertake this meta-analysis as a feasible approach to clarify the associations between HU, gout or ULT, and OA.

Discussions:

This meta-analysis will help to strengthen our knowledge of the pathogenesis of OA and promote the development of preventive or treatment strategies.

Registration:

PROSPERO registration number CRD42020168769.
Exon 21 deletion in the OPHN1 gene in a family with syndromic X-linked intellectual disability
Authors: Bogliş Alina , Cosma Adriana S. , Tripon Florin , Bãnescu Claudia
Published: August 2020

Introduction:

The oligophrenin-1 (OPHN1) gene, localized on the X chromosome, is a Rho-GTPase activating protein that is related to syndromic X-linked intellectual disability (XLID). XLID, characterized by brain anomalies, namely cerebellar hypoplasia, specific facial features, and intellectual disability, is produced by different mutations in the OPHN1 gene.

Patient concerns:

In this report, we present the clinical and molecular findings of a family affected by a mild XLID due to a deletion in the OPHN1 gene, exon 21, Xq12 region using Multiplex Ligation-dependent Probe Amplification (MLPA) analysis. The clinical features present in the family are a mild developmental delay, behavioral disturbances, facial dysmorphism, pes planus, nystagmus, strabismus, epilepsy, and occipital arachnoid cyst.

Interventions:

The MLPA analysis was performed for investigation of the copy number variations within the X chromosome for the family.

Diagnosis and outcome:

The MLPA analysis detected a deletion in the OPHN1 gene, exon 21 for the proband, and a heterozygous deletion for the probands mother. The deletion of the Xq12 region of maternal origin, including the exon 21 of the OPHN1 gene, confirmed for the probands nephew.

Lessons:

Our findings emphasize the utility of the MLPA analysis to identify deletions in the OPHN1 gene responsible for syndromic XLID. Therefore, we suggest that MLPA analysis should be performed as an alternative diagnostic test for all patients with a mild intellectual disability associated or not with behavioral disturbances, facial dysmorphism, and brain anomalies.
Pseudodiphallia: a rare kind of diphallia
Authors: Zhang Wenchao , Yu Nanze , Liu Zhifei , Wang Xiaojun
Published: August 2020

Rationale:

Pseudodiphallia, as a rare kind of diphallia, which is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. Only a few cases have been reported. Here, we report a case of pseudodiphallia with phimosis and bilateral extrarenal pelvis.

Patient concerns:

A 23-year-old male visited our hospital with a complaint of external genitalia malformation. Physical examination revealed a normal-sized penis with phimosis, and an extra half glans horizontally attached to the right side of the normal glans penis is visible after completely retracting the foreskin. The CT urography showed a bilateral extrarenal pelvis, and no other abnormalities were found in the kidneys, ureter, bladder, and vertebral bodies.

Diagnosis:

Based on the physical examination and the CT urography results, the 23-year-old male was diagnosed with Pseudodiphallia.

Intervention:

Excessive penile tissue was resected, and a foreskin circumcision operation was performed under general anesthesia.

Outcomes:

The patient recovered smoothly without complications (no infection, hematoma, or wound dehiscence) after surgery. At 6 months follow-up, the patient was content with the external genitalia's appearance, and the urination and erectile function were normal.

Lessons:

Pseudodiphallia is a rare kind of diphallia, and this is the first report on pseudodiphallia with a bilateral extrarenal pelvis. CT urography can be used to assess the associated internal anomalies before surgery.
Association of the duration of post-thaw culture with clinical outcome after vitrified-warmed day 3 embryo transfer in 10,464 cycles
Authors: Zhu Haiyan , Xu Wen , Jin Xiaoying , Xue Yamei , Tong Xiaomei , Zhang Songying
Published: August 2020

This study aimed to investigate the effect of the duration of embryo culture on clinical outcome in vitrified-warmed cycles.

This retrospective cohort study enrolled 10,464 infertile patients, with a total of 18,843 vitrified-warmed day 3 embryos from 2012 to 2017 at a single center. The patients were divided into 2 groups: 9470 cycles in the short-term culture group (0.5–8 hours of post-thaw culture) and 994 cycles in the 48 to 72 hours culture group. The independent effect of the following variables on clinical outcomes was determined: duration of post-thaw culture, maternal age, transferred embryos, embryo quality, and endometrial thickness.

We found that the pregnancy rate was positively associated with the post-thaw culture time. Ordinary least square regression analyses showed that the duration of post-thaw culture was positively associated with implantation and live birth rates overall. However, the implantation and live birth rates were not significantly associated with the post-thaw culture time in the short-term culture group. Additionally, maternal age and the number of transferred embryos were independent predictors of the implantation and live birth rates. Moreover, the duration of post-thaw culture did not affect live birth weight.

These results indicated that the pregnancy rate is positively associated with the duration of post-thaw culture. Therefore, under the condition of not affecting work shifts, properly prolonging the duration of post-thaw culture to improve the outcome of frozen-thawed embryo transfer should be considered.
Impact of thyroid ultrasonography combined ultrasound-guided fine-needle aspiration biopsy in detection thyroid microcarcinoma
Authors: Han Zhuan-Ning , Liu Zhe , Wang Jing
Published: August 2020

Background:

This study aims to explore the accuracy of thyroid ultrasonography (TUS) combined ultrasound-guided fine-needle aspiration biopsy (UGFNAB) for detection of thyroid microcarcinoma (TMC).

Methods:

A comprehensive search in PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the beginning to the June 1, 2020 without language and publication status limitations. Two authors will independently perform articles identification, data extraction and assessment of study quality. Any disagreements will be resolved by discussion with a third author. We will carry out study quality evaluation using Quality Assessment of Diagnostic Accuracy Studies tool, and will employ statistical analysis using RevMan V.5.3 and Stata V.12.0 softwares.

Results:

We will summarize current evidence to investigate the accuracy of TUS combined UGFNAB in detection of TMC.

Conclusion:

The findings of this study may provide helpful evidence of TUS combined UGFNAB in detection of TMC.

Study registration:

INPLASY202070048.
Acupuncture improves postoperative symptoms of pigmented villonodular synovitis
Authors: Tang Hongzhi , Fan Huaying , Luo Fei , Huang Li , Liao Shichuan , Yu Wenjing , Chen Yunbei , Chen Jiao , Qin Xuefei
Published: August 2020

Background:

Pigmented villonodular synovitis (PVNS) is a benign proliferative disease of synovial joint, synovial sac and tendon sheath. PVNS is usually treated by surgery, but postoperative joint dysfunction and pain will be accompanied, which seriously affects the quality of life. The purpose of this review is to evaluate the effectiveness and safety of this intervention in patients with pain and dysfunction caused by postoperative symptoms of PVNS.

Methods:

We will search the EMBASE, the Cochrane Library, Ovid MEDLINE, PubMed, Web of Science, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP (VIP), the US National Institute of Health, the NIH clinical registry Clinical Trials, the ICTRP, and the Australian New Zealand Clinical Trials Registry and the Chinese clinical registry, from their inception to 1st July 2020. Randomized controlled trials that include patients with postoperative symptoms of pigmented villonodular synovitis receiving acupuncture therapy versus a control group will be included. The selection of studies, data extraction and risk of bias assessment will be conducted by 2 independent researchers. A third review author resolved disagreements. The dichotomous data will be presented as risk ratios with 95% confidence intervals (CIs) and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated using the GRADE system.

Results:

The results will be disseminated through a peer-reviewed journal publication.

Conclusions:

This systematic review will provide updated evidence of various types of acupuncture specifically focuses on its effectiveness and safety for patients’ pain and dysfunction caused by post-operation of pigmented villonodular synovitis.

Ethics and dissemination:

Ethical approval is not necessary as this review will not require data from individual patients. The results of this will be published through peer-reviewed journal articles or conference presentations.

Registration:

Open Science Framework (OSF). 2020, July 7. 10.17605/OSF.IO/CZW9P.
Spontaneous spinal epidural hematoma masquerading as atypical abdominal pain in a child
Authors: Cheng Xueliang , Qu Yang , Dong Rongpeng , Yang Lili , Kang Mingyang , Zhao Jianwu
Published: August 2020

Introduction:

There have been few case reports of abdominal pain as a symptom of spontaneous intraspinal hemorrhage. We herein describe a case involving a girl with paraplegia caused by spontaneous epidural hemorrhage in the thoracic spinal canal, characterized by abdominal pain.

Patient concerns:

An 8-year-old girl with sudden abdominal pain and back pain was misdiagnosed as having an abdominal disease until she had the symptom of paralysis.

Diagnoses:

The patient was diagnosed with spontaneous intraspinal hemorrhage masquerading as atypical abdominal pain.

Interventions:

When the patient developed symptoms of lower extremity paralysis, thoracic magnetic resonance imaging was performed and epidural hemorrhage was found in the thoracic spinal canal. Surgical treatment was performed after the diagnosis was confirmed.

Outcomes:

The patient could almost walk normally after 3 months. One year after surgery, the Frankel grade of spinal cord function was grade D. We continued to follow-up this patient.

Conclusion:

The symptoms caused by intraspinal hemorrhage are mainly back pain with or without neurological dysfunction. However, sometimes atypical symptoms, such as abdominal and chest pain, can be identified in clinical settings. Emergency surgery is recommended as the treatment of choice for intraspinal hemorrhage with neurological dysfunction.
Minimally invasive plate osteosynthesis or conventional intramedullary nailing for distal tibial fractures
Authors: Song Xin , Huang Xun , Yakufu Maihemuti , Yan Bin , Feng Chencheng
Published: August 2020

Background:

Currently, both minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing are the two most commonly used methods of treatment in distal tibial fractures, but controversy still exists regarding the clinical effects of 2 techniques. Our purposes were to compare MIPO and intramedullary nailing for distal tibia shaft fractures by assessing functional outcomes and complications.

Methods:

Data were collected retrospectively from the charts of patients treated for distal tibial extra-articular fractures between May 2012 and July 2018. All cases were performed by a single surgeon. Institutional review board approval in the Second Affiliated Hospital of Army Medical University was obtained prior to conducting chart review and analysis. The criteria for inclusion in the study were being aged at least 18 years at the time of diagnosis and having a closed or type I open fracture of the distal third of the tibial diaphysis. The primary outcome compared between the 2 groups was the American Orthopedic Foot and Ankle surgery score. The secondary outcome measures in this trial included Olerud and Molander Ankle Score, radiographic outcomes, and complications. Statistical analysis was performed using SPSS version. P values < .05 were considered statistically significant.

Results:

We hypothesized that MIPO would be associated with better functional outcomes and fewer complications.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5808).
A personalized treatment program in persons with type 2 diabetes is associated with a reduction in liver steatosis
Authors: Björkström Karl , Stål Per , Holmer Magnus , Bengtsson Bonnie , Staaf Annika , Hoffstedt Johan , Hagström Hannes
Published: August 2020

Background and aims

It is unclear if improving glycemic control in persons with type 2 diabetes (T2D) also has liver-related effects. We aimed to evaluate if a personalized treatment program associates with improvement of liver-related parameters in persons with advanced T2D in a real-life setting.

Methods

Persons with advanced T2D underwent a 4-day personalized treatment program, with the aim of improving glycemic control by dietary advice, instructions on how to achieve optimal glucose control and individualized dosage of medications. Transient elastography was used to estimate liver steatosis and fibrosis. Persons with liver diseases other than non-alcoholic fatty liver disease (NAFLD) were excluded. After 3 months, study participants were offered re-examination.

Results

Ninety-one persons were included. Of these, 75 persons (82%) had controlled attenuation parameter (CAP) measurements of acceptable quality at baseline. Of these, 57 (76%) had NAFLD (defined as >268 dB/m). Twenty-two persons (24%) had elevated liver stiffness (>7.9 kPa), and eight (9%) had liver stiffness above 13.9 kPa, indicating advanced fibrosis. Over a median follow-up of 101 days, mean CAP in persons with NAFLD was reduced by 18.33 dB/m (P = 0.035). In persons with elevated liver stiffness, mean stiffness was reduced by 2.6 kPa (P = 0.047). In linear regression, one-unit improvement in fasting glucose (mg/dl) was associated with a decrease in hepatic steatosis with 0.48 dB/m (adjusted R2 = 0.35, P < 0.01).

Conclusion

The prevalence of NAFLD with advanced fibrosis is high in persons with advanced T2D. Improving glycemic control through a personalized treatment program is associated with a reduction in liver steatosis and stiffness in this cohort.
Presentation and Outcomes of Autoimmune Hepatitis Type 1 and Type 2 in Children
Authors: Roepe Isaiah G. , Vierling John M. , Goss John A. , Miloh Tamir
Published: August 2020

Objective:

Autoimmune hepatitis (AIH) is designated as type 1 or 2 (AIH‐1/2) on the basis of serum autoantibody (Ab) profiles. In children, AIH may present as acute or chronic liver failure or cirrhotic AIH (ALF/CLF/CAIH) with or without overlap sclerosing cholangitis (SC). The aim of this study was to compare demographics, presentation, and outcomes between groups in children.

Methods:

A retrospective electronic chart review of children with AIH who met standard diagnostic criteria with histologic confirmation at Texas Children's Hospital was performed, with de novo AIH after liver transplant (LT) excluded. Patients were identified and divided into AIH‐1, AIH‐2, ALF, CAIH, AIH‐SC, and LT and compared using chi‐square analysis, Student t‐test, and Mood median test.

Results:

Among 91 children with AIH, 72 (79.1%) had AIH‐1, 19 (20.9%) had AIH‐2, 13 (14.3%) had ALF, 25 (27.5%) had CAIH, and 14 (15.4%) had AIH‐SC. Both AIH‐1/2 had female and Hispanic predominance (72.2/89.5%, 40.3/57.9%). AIH‐2 presented at younger mean age in years than AIH‐1 (6.8, 12.1, P < 0.05). Both AIH‐1/2 had low rates of remission after 1 year of IS (25.4, 35.7%) and most recent (30.6, 54.5%) follow‐up. Twenty‐two (24.2) patients received LT: 16 had AIH‐1 (72.7%), 6 had AIH‐2 (27.3%), 9 (40.9%) had ALF, and 13 (59.1%) had CAIH. One‐year patient and graft survivals were 100%.

Conclusions:

The epidemiology and clinical presentation of AIH‐1 and ‐2 had a few subtle differences. AIH‐1 was associated with more complications after LT. More data are needed to better characterize the 2 as separate disease entities.
Clinicopathologic Features of Low-grade Appendiceal Mucinous Neoplasm
Authors: Bell Phoenix D. , Huber Aaron R. , Drage Michael G. , Barron Samuel L. , Findeis-Hosey Jennifer J. , Gonzalez Raul S.
Published: August 2020

Low-grade appendiceal mucinous neoplasm (LAMN) is an enigmatic tumor that lacks the capacity for classic invasion but can dissect through the appendiceal wall, causing pseudomyxoma peritonei (PMP). Most large studies of the histologic spectrum of LAMN and its rate of associated PMP include cases submitted from outside institutions, potentially skewing their findings. We identified 117 cases of LAMN at our institution. Hematoxylin and eosin-stained slides from each were reviewed, and clinical and pathologic parameters were noted. The patients were 76 females and 41 males, with a mean age of 60 years. Presenting symptoms were available for 113 patients; the majority (56%) were symptomatic, typically with abdominal pain. Ninety-one tumors (78%) were grossly dilated, and the entire appendix was submitted in 88 (75%) cases. Median lesion size was 5.5 cm. Ninety-two cases (79%) demonstrated epithelial denudation; these were often markedly dilated and contained intraluminal or mural microcalcifications. Thirty-two (27%) had a mucosal Schwann cell proliferation. On the basis of the American Joint Committee on Staging eighth edition cancer staging manual, of 117 cases, 66% were staged as pTis, 9% as pT3, 24% as pT4a, and 2% as pT4b. Ten cases (9%) were associated with histopathologic evidence of disseminated PMP. Only 1 patient died of disease, while 3 were alive with disease at last follow-up. Previous LAMN studies have utilized both departmental and extradepartmental material; our single-institution review demonstrated lower rates of PMP than some prior studies. Some LAMNs may be markedly dilated with extensive denudation, making the diagnosis difficult to confirm microscopically and ultimately requiring submission of the entire appendix for histologic evaluation.
Extubation Failure and Major Adverse Events Secondary to Extubation Failure Following Neonatal Cardiac Surgery*
Authors: Miura Shinya , Jardim Peter V. , Butt Warwick , Namachivayam Siva P.
Published: August 2020

Objectives:

To describe the prevalence and consequences of major adverse events secondary to extubation failure after neonatal cardiac surgery.

Design:

A single-center cohort study.

Setting:

A medical-surgical, 30-bed PICU in Victoria, Australia.

Patients:

One thousand one hundred eighty-eight neonates less than or equal to 28 days old who underwent cardiac surgery from January 2007 to December 2018.

Interventions:

None.

Measurements and Main Results:

Extubation failure was defined as unplanned reintubation within 72 hours after a planned extubation. Major adverse event was defined as one or more of cardiac arrest, emergency chest reopening, extracorporeal membrane oxygenation, or death within 72 hours after extubation. One hundred fifteen of 1,188 (9.7%) neonates had extubation failure. Hospital mortality was 17.4% and 2.0% in neonates with and without extubation failure. Major adverse event occurred in 12 of 115 reintubated neonates (10.4%). major adverse event included cardiac arrest (n = 10), chest reopening (n = 8), extracorporeal membrane oxygenation (n = 5), and death (n = 0). Cardiovascular compromise accounted for major adverse event in eight: ventricular dysfunction (n = 3), pulmonary overcirculation (n = 2), coronary ischemia (n = 2), cardiac tamponade (n = 1). In a multivariable logistic regression, factors associated with major adverse event were high complexity in cardiac surgery (odds ratio 5.9; 95% CI: 1.1–32.2) and airway anomaly (odds ratio 6.0; 95% CI: 1.1–32.6). Hospital morality was 25% and 17% in reintubated neonates with and without major adverse event.

Conclusions:

Around 10% of reintubated neonates suffered major adverse event within 72 hours of extubation. Neonates suffering major adverse event had high mortality. Major adverse event should be monitored and reported in future studies of extubation failure. Along with tracking of extubation failure rates, major adverse event secondary to extubation failure may also serve as a key performance indicator for ICUs and registries.
Effects of Blood Flow Restriction Training on Muscle Strength and Pain in Patients With Knee Injuries
Authors: Li Shuoqi , Shaharudin Shazlin , Abdul Kadir Mohammed Rafiq
Published: August 2020

Background

Due to the pain caused by knee injuries, low-load resistance training with blood flow restriction (L-BFR) may be a potential adjuvant therapeutic tool in the rehabilitation of knee injuries. This review aimed to analyze the effectiveness of L-BFR training modality in knee rehabilitation.

Design

A meta-analysis was conducted to determine the potential impact of blood flow restriction on patients with knee injuries. PubMed, EBSCO, and Web of Science databases were searched for eligible studies from January 2000 until January 2020. The mean differences of the data were analyzed using Revman 5.3 software with a 95% confidence interval.

Results

Nine studies fulfilled the inclusion criteria. These studies involved 179 patients who received L-BFR, 96 patients who underwent high-load resistance training, and another 94 patients who underwent low-load resistance training. The analysis of pooled data showed that patients in both the L-BFR (standardized mean difference, 0.83 [0.53, 1.14], P < 0.01) and high-load resistance training (standardized mean difference, −0.09 [−0.43, 0.24], P = 0.58) groups experienced an increase in muscle strength after the training. In addition, pain score was significantly reduced in the L-BFR group compared with the other two groups (standardized mean difference, −0.61 [−1.19, −0.03], P = 0.04).

Conclusions

Muscle strength increased after L-BFR and high-load resistance training compared with low-load resistance training. Furthermore, pain score was significantly reduced after L-BFR. Hence, L-BFR is a potential intervention to be applied in rehabilitation of knee injuries.
African American Patient Disparities in COVID-19 Outcomes
Authors: Odonkor Charles A. , Sholas Maurice G. , Verduzco-Gutierrez Monica , Zafonte Ross D. , Silver Julie K.
Published: August 2020

SARS-CoV-2 is a novel and highly contagious coronavirus that has been a major threat to the public’s health. As the pandemic has spread across the United States, it has become abundantly clear that vulnerable populations include not only the elderly and individuals with disabilities but also those who are homeless or incarcerated, Latinx Americans, African Americans, and Native Americans. This report is focused on the experience of Black patients, inclusive of African Americans, and recognizes the higher morbidity and mortality in this population. Physiatrists can provide care for the sequelae faced by survivors and prioritize rehabilitation services. Programs must be administered in a way that is geographically accessible to Black communities and demonstrate cultural competence. Future research should focus on the social determinants of health to better understand at-risk populations and improve outcomes.
Sino-Cutaneous Fistula After Using Medpor Implant in Orbital Blowout Fracture
Authors: Kim Jin Il , Cheon Tae Uk , Kim Tae Koon , Nam Jung Gwon
Published: August 2020

In surgical repair of orbital fracture, implant materials play an important role in restoring the functional and anatomic structure of the orbit. Alloplastic implant materials are widely used for this surgery, but they have the risk of complications such as infections, pain, and extrusion. Because they are artificial implants, infection can occur more than autologous implants and is the most challenging problem to manage. Sino-cutaneous fistula is a rare complication of chronic sinusitis and it can be caused by this implant materials. The authors report a case of formation of sino-cutaneous fistula after using Medpor (Stryker Co, MI) implant in orbital blowout fracture repair.
Epidermoid and Dermoid Cysts of the Head and Neck
Authors: Pupić-Bakrač Jure , Pupić-Bakrač Ana , Bačić Ivan , Kolega Marija Škara , Skitarelić Neven
Published: August 2020

Epidermoid and dermoid cysts (ECs and DCs) are congenital anomalies occurring in areas of embryonic fusion. Their incidence in the head and neck region is low and ranges from 1.6% to 7%. The aim of this study is to report on the clinical characteristics, treatment, and outcome of 22 patients from a single-institution experience. A retrospective analysis of patients treated for ECs and DCs of the head and neck over a 12-year period was performed. The present study included 22 patients (male/female ratio 1:1). The mean age of presentation was 11.68 years. The lesions were distributed in the orbital regions in 7 (31.82%) patients, auricular regions in 6 (27.27%), neck regions in 5 (22.73%), floor of the mouth in 3 (13.64%), and nose in 1 (4.55%). Complete surgical excision was performed as a definitive treatment method in 21 patients (95.45%). The mean size of the excised lesions was 21.36 mm at the widest length (range: 10–70 mm). On the basis of histopathological examinations, 15 (71.43%) lesions were classified as ECs and 6 (28.57%) as DCs. Post-operative complications were noted in 3 (14.29%) patients––2 (9.52%) with recurrences and 1 (4.76%) with hypertrophic scarring. All of these patients were successfully cured after a second surgery. The ECs and DCs of the head and neck present an interesting diagnostic and therapeutic challenge. Successful management depends on a thorough knowledge of their clinical and radiological features.
Hereditary transthyretin amyloidosis: current treatment
Authors: Adams David , Slama Michel
Published: August 2020

Purpose of review

Hereditary transthyretin amyloidosis (ATTRv) is a rare autosomal dominant, life-threatening disease. Until recently only early stages of ATTRv-PN (polyneuropathy) had access to disease-modifying therapy (DMT), whereas there was no specific treatment for ATTRv-CM (cardiomyopathy). This review updates our knowledge about results of three phase 3 clinical trials, expert's consensus for early diagnosis and emerging biomarkers.

Recent findings

Two phase 3 studies using RNAi and antisense oligonucleotides (ASO) were successful. Primary endpoints were progression of neuropathic score mNIS +7 and quality of Life (QOL) in a population of ATTRv-PN at different levels of severity. They knock downed circulating amyloidogenic mutant and wild-type TTR. Safety concerned ASO with a risk of thrombocytopenia. RNAi showed possible reversibility of the disease. Phase 3 ATTRACT trial-tested tafamidis versus placebo in patients with ATTRv-CM and ATTRwt-CM and showed a significant reduction of all-cause mortality and rates of cardiovascular-related hospitalizations. All three drugs obtained marketing authorization by European Medicines Agency (EMA) and Food and drug administration (FDA). Early diagnosis criteria for ATTRv-PN and ATTRv-CM are available. Ongoing clinical trials for ATTRv are presented. New biomarkers are plasma neurofilament light chain, intraepidermal nerve fiber density.

The majority of patients with ATTRv may have now access to a DMT. Criteria for early diagnosis are available.
COVID-19 in rheumatic diseases: A random cross-sectional telephonic survey
Authors: Goswami Rudra Prosad , Kumar Uma , Kanjilal Maumita , Ray Debaditya , Vij Pallavi , Mittal Dheeraj K , Meena Laxman , Nagar Sandeep , Bhadu Danveer
Published: August 2020

Objective

To describe the incidence, clinical course, and predictive factors of coronavirus 2019 (COVID-19) infection in a cohort of rheumatological patients residing in New Delhi (National Capital Region), India.

Methods

We performed a cross-sectional, random telephonic survey from 20th April to 20th July 2020 on patients with rheumatic diseases. Patients were interviewed with a predesigned questionnaire. The incidence of COVID-19 in the general population was obtained from open access government data repository. Report of reverse transcriptase polymerase chain reaction report was taken as confirmatory of COVID-19 infection.

Results

Among the 900 contacted patients 840 responded (713 with rheumatoid arthritis (RA), 100 with systemic lupus erythematosus (SLE), 20 with spondylarthritis (SpA) and 7 with others; mean age 45 ±13 years, mean duration 11.3 ± 6.3 years; 86% female). Among them 29 reported flu-like symptoms and four RA patients had confirmed COVID-19 infection. All of them were hospitalized with uneventful recovery. Rheumatological drugs were discontinued during the infectious episode. Disease modifying agents and biologics were equally received by those with or without COVID-19. The incidence of COVID-19 was similar to general Delhi population (0.476% vs 0.519% respectively, p=0.86). Two patients had relapse of rheumatic disease after recovery. After recovery from COVID-19 or Flu-like illness, eight patients (27.6%, 95% confidence interval 14.7-45.7) reported disease flare.

Conclusion

Patients with rheumatic diseases in India have similar incidence of COVID-19 infection compared to the community. Relapse of underlying rheumatic disease after recovery is not uncommon and continuation of glucocorticoid through the infection should be considered.
A highly specific assay for the detection of SARS-CoV-2-reactive CD4+ and CD8+ T cells in COVID-19 patients
Authors: Zelba Henning , Worbs David , Harter Johannes , Pieper Natalia , Kyzirakos-Feger Christina , Kayser Simone , Seibold Marcel , Bartsch Oliver , Ködding Jiri , Biskup Saskia
Published: August 2020

Gaining detailed insights into the role of host immune responses in viral clearance is critical for understanding COVID-19 pathogenesis and future treatment strategies. While studies analyzing humoral immune responses against SARS-CoV-2 were available rather early during the pandemic, cellular immunity came into focus of investigations just recently.

For the present work, we have adapted a protocol, designed for the detection of rare neoantigen-specific Memory T cells in cancer patients for studying cellular immune responses against SARS-CoV-2. Both, CD4+ and CD8+ T cells were detected after 6 days of in vitro expansion using overlapping peptide libraries representing the whole viral protein. The assay readout was an Intracellular cytokine staining and flow cytometric analysis detecting four functional markers simultaneously (CD154, TNF, IL-2, IFN-γ).

We were able to detect SARS-CoV-2-specific T cells in 9 of 9 COVID-19 patients with mild symptoms. All patients had reactive T cells against at least one of 12 analyzed viral antigens and all patients had Spike-specific T cells. While some antigens were detected by CD4+ and CD8+ T cells, Membrane protein was mainly recognized by CD4+ T cells. Strikingly, we were not able to detect SARS-CoV-2-specific T cells in 9 unexposed healthy individuals.

We are presenting a highly specific protocol for the detection of SARS-CoV-2-reactive T cells. Our data confirmed the important role of cellular immune responses in understanding SARS-CoV-2 clearance. We showed that Spike is the most immunogenic antigen. We have introduced Membrane protein as interesting target for studying humoral immune responses in convalescent COVID-19 patients.
Decontamination of SARS-CoV-2 and other RNA viruses from N95 level meltblown polypropylene fabric using heat under different humidities
Authors: Campos Rafael K. , Jin Jing , Rafael Grace H. , Zhao Mervin , Liao Lei , Simmons Graham , Chu Steven , Weaver Scott C , Chiu Wah , Cui Yi
Published: August 2020

In March of 2020, the World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic led to a shortage of N95-grade filtering facepiece respirators (FFRs), especially for protection of healthcare professionals against airborne transmission of SARS-CoV-2. We and others have previously reported promising decontamination methods that may be applied to the recycling and reuse of FFRs. In this study we tested disinfection of three viruses including SARS-CoV-2, dried on a piece of meltblown fabric, the principal component responsible for filtering of fine particles in N95-level FFRs, under a range of temperatures (60-95°C) at ambient or 100% relative humidity (RH) in conjunction with filtration efficiency testing. We found that heat treatments of 75°C for 30 min or 85°C for 20 min at 100% RH resulted in efficient decontamination from the fabric of SARS-CoV-2, human coronavirus NL63 (HCoV-NL63), and another enveloped RNA virus, chikungunya virus vaccine strain 181 (CHIKV-181), without lowering the meltblown fabric’s filtration efficiency.