bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Impact of an Innovative Educational Program for Skin Care Champions Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test
Authors: Delmore Barbara , Smith Daniel J. , Savage Elizabeth , Ayello Elizabeth A.
Published: April 2020

OBJECTIVE

To assess pressure injury knowledge of Skin Care Council nursing members using the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), to design an educational intervention informed by the results of the baseline assessment, and to evaluate the effect of the intervention.

METHODS

This was a single-group pretest-posttest project conducted in an urban, academic, tertiary medical center from January to August 2017. Participants were measured on the pretest, received the intervention, and then were reevaluated on the posttest 3 months later. Pretest results informed the design of the intervention, which was a 1-day interactive, targeted educational program referred to as the “Skin Care Council Boot Camp.” Paired-samples t tests were conducted to examine differences between pretest and posttest scores on the PZ-PUKT overall and in each test section.

RESULTS

Seventy-seven participants enrolled in the project and completed the pretest. Of those, 58 (75.3%) were retained through the intervention and the posttest evaluation. Participants had a mean pretest score of 78.9 and a mean posttest score of 85.3. There were significant mean differences among pretest and posttest PZ-PUKT scores: 6.4 (t = 9.419, P < .001) overall; 4.6 (t = 5.356, P < .001) in the Prevention/Risk category; 4.1 (t = 3.668, P < .001) in the Staging category; and 10.5 (t = 7.938, P < .001) in the Wound Description category.

CONCLUSIONS

By testing pressure injury knowledge before developing a program, investigators created a tailored, education program that addressed knowledge gaps. Posttest results provided insight into the program’s success and opportunities for future improvement.
Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment
Authors: Jamieson Denise J. , Steinberg James P. , Martinello Richard A. , Perl Trish M. , Rasmussen Sonja A.
Published: April 2020

As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care–associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.
Nonspatial Features Reduce the Reliance on Sustained Spatial Auditory Attention
Authors: Bonacci Lia M. , Bressler Scott , Shinn-Cunningham Barbara G.
Published: April 2020

Objective:

Top-down spatial attention is effective at selecting a target sound from a mixture. However, nonspatial features often distinguish sources in addition to location. This study explores whether redundant nonspatial features are used to maintain selective auditory attention for a spatially defined target.

Design:

We recorded electroencephalography while subjects focused attention on one of three simultaneous melodies. In one experiment, subjects (n = 17) were given an auditory cue indicating both the location and pitch of the target melody. In a second experiment (n = 17 subjects), the cue only indicated target location, and we compared two conditions: one in which the pitch separation of competing melodies was large, and one in which this separation was small.

Results:

In both experiments, responses evoked by onsets of events in sound streams were modulated by attention, and we found no significant difference in this modulation between small and large pitch separation conditions. Therefore, the evoked response reflected that target stimuli were the focus of attention, and distractors were suppressed successfully for all experimental conditions. In all cases, parietal alpha was lateralized following the cue, but before melody onset, indicating that subjects initially focused attention in space. During the stimulus presentation, this lateralization disappeared when pitch cues were strong but remained significant when pitch cues were weak, suggesting that strong pitch cues reduced reliance on sustained spatial attention.

Conclusions:

These results demonstrate that once a well-defined target stream at a known location is selected, top-down spatial attention plays a weak role in filtering out a segregated competing stream.
Treatment options in BRAF-mutant metastatic colorectal cancer
Authors: Bernabe-Ramirez Carolina , Patel Rajvi , Chahal Jaspreet , Saif Muhammad Wasif
Published: April 2020

B-type Raf kinase (BRAF) mutations occur in approximately 10% of patients with metastatic colorectal cancers (mCRC). Tumors harboring this mutation have a unique molecular profile and clinical phenotype. Response rate to systemic chemotherapy is poor and associated with shorter survival rate. Although BRAF inhibition dramatically changed treatment for melanoma patients, similar clinical responses were not observed in BRAF-mutant CRC, proposing a distinct mechanism of carcinogenesis. The aggressive biology of BRAF-mutated mCRC has underlined the importance of developing new therapeutic agents to improve outcomes in these patients. Despite numerous attempts, chemotherapy regimens are limited for this population. Reactivation of mitogen activated protein kinase pathway may explain the resistance to monotherapy, thus different combinations to target the pathway at different levels have been studied. This article will describe most suitable treatment options for CRC patients with BRAF mutation and discuss new emerging agents.
High expression of TRAF4 predicts poor prognosis in tamoxifen-treated breast cancer and promotes tamoxifen resistance
Authors: Zhou Jun , Li Wenhui , Ming Jie , Yang Wen , Lu Linlin , Zhang Qiulei , Ruan Shengnan , Huang Tao
Published: April 2020

Tamoxifen is the main adjuvant endocrine therapeutic agent for patients with estrogen receptor positive breast cancer. However, the resistance to tamoxifen has become a serious clinical challenge and the underlying mechanisms are still poorly understood. TRAF4 is a member of tumor necrosis factor receptor-associated factor family and its role in tamoxifen resistance has not been found. In this study, we aimed to explore the roles of TRAF4 in tamoxifen-treated breast cancer and tamoxifen resistance. Through high-throughput sequencing and differential gene expression analyses, TRAF4 was identified as the research object in this study. The prognosis significance of TRAF4 was studied based on 155 tamoxifen-treated breast cancer patients obtained from Gene Expression Omnibus (GEO) database. We then investigated the TRAF4 expression level in tamoxifen-resistant and the tamoxifen-sensitive breast cancer cell lines with western blot and real-time quantitative PCR. The loss- and gain-of-function assay of TRAF4 in a tamoxifen-resistant cell line was evaluated using colony formation experiments and cell count kit-8 assay. We identified that TRAF4 was overexpressed in tamoxifen-resistant breast cancer cell line and TRAF4 overexpression was associated with worse overall survival (hazard ratio = 2.538, P = 0.017) and cancer-specific survival (hazard ratio = 2.713, P = 0.036) in tamoxifen-treated patients. Knockdown of TRAF4 reversed tamoxifen resistance, while overexpression of TRAF4 increased tamoxifen resistance, which confirmed the role of TRAF4 in tamoxifen resistance. Taken together, our study demonstrated that TRAF4 could be a novel prognostic biomarker for tamoxifen-treated breast cancer patients and a potential therapeutic target for tamoxifen resistance.
A Prospective Study About Trastuzumab-induced Cardiotoxicity in HER2-positive Breast Cancer
Authors: Ben Kridis Wala , Sghaier Syrine , Charfeddine Salma , Toumi Nabil , Daoud Jamel , Kammoun Samir , Khanfir Afef
Published: April 2020

Background:

Trastuzumab improves therapeutic outcomes among patients with human epidermal growth factor receptor 2–positive breast cancer (BC). However, it is associated with a risk of treatment-induced cardiotoxicity. The aims of this study were to determine the frequency of trastuzumab-induced cardiotoxicity (TIC) in Tunisian patients, to study the effects of trastuzumab on cardiac biomarkers and echocardiographic parameters using the speckle tracking technique and to identify risk factors of occurrence of TIC.

Patients and Methods:

Fifty women with newly diagnosed human epidermal growth factor receptor 2–positive BC treated with or without anthracycline followed by taxane and trastuzumab were enrolled, from November 2016 to December 2018, to be evaluated every 3 months during trastuzumab treatment (total of 15 mo) using echocardiograms and blood samples. Left ventricular ejection fraction (LVEF) and peak systolic left ventricular longitudinal myocardial strain were calculated. Ultrasensitive troponin I (TNI) and N-terminal pro–B-type natriuretic peptide (NT pro-BNP) were also measured.

Results:

LVEF decreased from 62±3.12% to 59±3.3% (P=0.005) over 15 months. Seven patients (14%) developed cardiotoxicity, as defined by the European Society of Cardiology; of these patients, 2 (4%) had symptoms of heart failure. Hypertension, left ventricular longitudinal myocardial strain, Log TNI, and NT pro-BNP measured at the completion of anthracyclines were significantly correlated to TIC occurrence. At multivariate analysis, the degree of LVEF decline was the only independent factor correlated to TIC (hazard ratio=2.4; 95% confidence interval=1.2-6.03; P=0.049). This TIC was reversible in 86% of cases.

Conclusion:

In patients with BC treated with trastuzumab, in addition to the evaluation of the LVEF, systolic longitudinal strain, TNI, and NT pro-BNP measured at the completion of anthracyclines are useful in the prediction of subsequent TIC.
Variability of Care of Infants With Severe Respiratory Syncytial Virus Bronchiolitis
Authors: Kadmon Gili , Feinstein Yael , Lazar Isaac , Nahum Elhanan , Sadot Efraim , Adam Dganit , Zamir Gur , Chodick Gabriel , Schiller Ofer
Published: April 2020

Background:

Viral bronchiolitis caused by respiratory syncytial virus (RSV) is a common childhood disease accounting for many hospitalizations worldwide. Some infants may clinically deteriorate, requiring admission to an intensive care unit. We aimed to describe diagnostic and therapeutic measures of bronchiolitis in Israeli pediatric intensive care units (PICUs) and evaluate intercenter variability of care.

Methods:

Medical records of all RSV-infected infants admitted to 5 Israeli PICUs over 4 RSV seasons were retrospectively reviewed.

Results:

Data on 276 infants with RSV-positive bronchiolitis, admitted to the participating PICUs were analyzed. Most of the infants were males with a mean admission age of 4.7 months. Approximately half of the infants had pre-existing conditions such as prematurity, cardiac disease or chronic lung disease. Respiratory distress was the most common symptom at presentation followed by hypoxemia and fever. There was significant variation in the methods used for RSV diagnosis, medical management and respiratory support of the infants. Furthermore, utilization of inhalational therapy and transfusion of blood products differed significantly between the centers. Although a bacterial pathogen was isolated in only 13.4% of the infants, 82.6% of the cohort was treated with antibiotics.

Conclusions:

Significant variation was found between the different PICUs regarding RSV bronchiolitis diagnosis, medical management and respiratory support, which may not be accounted for by the differences in baseline and clinical characteristics of the infants. Some of these differences may be explained by uneven resource allocations. This diversity and the documented routine use of medications with weak evidence of efficacy calls for national guidelines for bronchiolitis management.
Ossifying Pilomatrixoma of the Eyelid
Authors: Charles Norman C. , Kim Eleanore T.
Published: April 2020

Pilomatrixoma, an uncommon, usually benign cutaneous appendageal tumor, shows differentiation toward the hair follicle matrix cell. It undergoes various histopathologic stages, early on displaying epithelial and shadow cells along with granulomatous inflammation. In later stages, illustrated by this unusual case, epithelial cells disappear and are replaced by calcification and ossification. Immunohistochemistry in the current case showed transitional cell reactivity for β-catenin, probably linking the tumor to a mutation in the β-catenin gene CTNNB1. There was also transitional cell positivity for cyclin D1, a marker found in matrical cells of the human hair follicle. While pilomatrixoma occurs occasionally in the eyelid, the ossified eyelid variant in the current case is very rare, with only one preceding description in the literature.
Coronavirus disease 2019 in children: Current status
Authors: Jeng Mei-Jy
Published: April 2020

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged from China in December 2019. The outbreak further exploded in Europe and America in mid-March 2020 to become a global health emergency. We reviewed recent published articles and on-line open messages on SARS-CoV-2–positive infants and children younger than 20 years of age. Symptoms are usually less severe in children than in adults. Twelve critically or mortally ill children were found in the published or news reports before April 6, 2020. Vertical transmission from the mother to her fetus or neonate has not been proven definitively. However, six early-onset (<7 days) and 3 late-onset neonatal SARS-CoV-2 infections were found in the literature. We also summarized the presentations and contact information of 24 SARS-CoV-2–positive children announced by the Taiwan Centers for Disease Control. Early identification and isolation, adequate management, prevention, and vaccine development are the keys to controlling the disease spread. Clinical physicians should be alert to asymptomatic children with COVID-19. Multidirectional investigations are crucial in the global fight against COVID-19.
Geriatric Nutritional Risk Index Score Predicts Clinical Outcome in Patients With Acute ST-Segment Elevation Myocardial Infarction
Authors: Jia Yu , Gao Yongli , Li Dongze , Cao Yu , Cheng Yisong , Li Fanghui , Xiao Lei , Jiang Ying , Wan Zhi , Zeng Zhi , Zeng Rui
Published: April 2020

Background

The Geriatric Nutritional Risk Index (GNRI), based on serum albumin levels and body index, is a simple nutrition-related risk assessment instrument.

Objective

We aimed to evaluate the prognostic value of GNRI in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

Methods

We retrospectively analyzed in-hospital and long-term adverse outcomes of 786 patients with STEMI. Patients were divided into 2 groups based on their GNRI score (≤98 vs >98). Kaplan-Meier curves and Cox regression models were used to evaluate the prognostic value of the GNRI score in patients with STEMI.

Results

Of the patients enrolled, 78 (9.9%) died of cardiovascular disease during the median follow-up period of 12.4 (8.3–15.5) months. Patients with a GNRI score of 98 or lower had a higher incidence of bleeding, cardiogenic shock, infection, acute respiratory failure, malignant dysrhythmia, atrial fibrillation, and in-hospital mortality as well as a longer length of hospital stay (P < .05). Kaplan-Meier survival analysis showed that patients with a lower GNRI score had lower cumulative survival (P < .001), regardless of age group (elderly vs middle-aged) or sex. Multivariable Cox regression analysis showed that the adjusted hazard ratio of the GNRI score for cardiovascular death was 0.934 (95% confidence interval, 0.896–0.974; P = .001).

Conclusion

The GNRI can be used to assess prognosis of patients with STEMI and to identify those who may benefit from further nutritional assessment and intervention.
Study on urinary metabolomics of premenstrual dysphoric disorder patients with liver-qi depression syndrome treated with Xiaoyaosan
Authors: Xu Mengbai , Liu Yanfeng , Guo Yu , Liu Chenyue , Liu Yueyun , Yan Zhiyi , Hou Yajing , Li Xiaojuan , Ma Qingyu , Zhou Xuan , Liu Liuqing , Huang Sheng , Chen Jiaxu
Published: April 2020

Introduction:

Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome with mental symptoms as its main manifestation, which seriously affects women's health and daily life. Some basic research and clinical studies have shown that the Chinese herbal medicine of Xiaoyaosan can relieve the symptoms of mental disorders with few side effects. The aim of this study is to evaluate the clinical efficacy of Xiaoyaosan for treating PMDD with liver-qi depression syndrome. In addition, metabonomics and small molecular marker compounds closely related to the pathogenesis of PMDD are expected to be found, and mechanism of Xiaoyaosan is further explored from the metabolic level.

Methods and analysis:

This study is a clinical pilot trial. Thirty PMDD patients with liver-qi depression syndrome and thirty healthy participants will be recruited. Study participants will be assigned in a 1:1 ratio to 2 groups: a normal control group and Xiaoyaosan treatment group. The treatment group will receive the Chinese patent medicine of Xiaoyaosan for 3 menstrual cycles. The primary outcome is the syndrome change in the Daily Record of Severity of Problems (DRSP). The secondary outcome is improvement in TCM syndrome, which will be measured with TCM symptom score scale. Urine metabolism profiles of participants by liquid chromatograph-mass spectrometer (LC-MS) method will be measured to explore the mechanism of PMDD pathogenesis and action of Xiaoyaosan on PMDD.

Discussion:

This trial will evaluate the effectiveness and the therapeutic mechanism from the metabolomics level of Xiaoyaosan in individuals with PMDD. If successful, the outcome of this trial will provide a viable treatment option for PMDD patients and objective evidence on the efficacy of Xiaoyaosan for PMDD.

Ethics and dissemination:

The trial has been approved by the Institutional Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (file number: DZMEC-KY-2019-73). Written informed consent will be obtained from all participants. The results of the study will be published in peer-reviewed journals or communicated via yearly reports to funding bodies.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR1900026296.
Evaluation of photobiomodulation in salivary production of patients with xerostomy induced by anti-hypertensive drugs
Authors: Varellis Maria Lucia Zarvos , Gonçalves Marcela Leticia Leal , Pavesi Vanessa Christina Santos , Horliana Anna Carolina Ratto Tempestini , de Fátima Teixeira da Silva Daniela , Motta Lara Jansiski , Barbosa Filho Valdomiro F. , Bezerra Cícero Dayves Silva , Silva Felipe Gonçalves da , Bussadori Sandra Kalil , Deana Alessandro M.
Published: April 2020

Introduction:

Hypertension (systemic arterial hypertension [SAH]) is a systemic condition that affects about 30% of the world population, according to data from the World Health Organization (WHO). Drugs used to control this disease have the potential to induce xerostomia, an oral condition in which the decrease of the salivary flow is observed and whose presence leads to the increase of the index of caries, periodontal disease, loss of the teeth, dysgeusia, difficulty of mastication, dysphagia, bad breath and oral burning and impairment of prothesis installed in the buccal cavity, including retention of removable and total dentures.

Methods:

This is a randomized, placebo-controlled, blind clinical protocol that aims to analyze the impact of phobiomodulation (PBM) on salivary glands of patients with antihypertensive drug induced xerostomia. Patients will be divided into 2 groups: G1: older adults with xerostomia induced by antihypertensive drugs and treatment with PBM (n = 30); G2: placebo PBM (n = 30). The irradiation will be made using a diode laser emitting at 808 nm with 100 mW and 40 seconds of exposure per site at the salivary glands. Twenty sites will be irradiated weekly for 4 weeks. Non-stimulated and stimulated salivary flow will be analyzed before and after the treatment.

Results:

This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs.

Conclusion:

This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs.

Trial registration:

Clinicaltrials.gov – NCT03632096
Maternal oral contraceptive pill use and the risk of atopic diseases in the offspring
Authors: Bai Xue-Feng , Wu Zheng-Xiang , Zhao Chun-Hong , Wu Yong , Fei Chang-Shun , Zhang Li-Qin , Chen Zhao-Hui
Published: April 2020

Studies of maternal oral contraceptive pill (OCP) exposure and the offspring's risk of atopic diseases are of current interest due to concerns about widespread use of OCP before or during pregnancy.

We evaluated whether maternal OCP exposure is associated with an increased risk of atopic diseases by reviewing the literature and performing a meta-analysis. The PubMed and Embase databases were searched to identify potential studies for inclusion. Three common atopic outcomes were included: asthma, eczema, and rhinitis.

We found 693 titles, abstracts, and citations, and 6 studies were included in this analysis. A meta-analysis revealed that maternal OCP exposure was associated with higher odds of asthma (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.02–1.19; P = .014), rhinitis (OR 1.34; 95% CI 1.07–1.68; P = .011) during childhood, whereas there was no association with eczema (OR 1.17; 95% CI 0.81–1.68; P = .383). This analysis was limited by the small number of studies included and the limited adjustments for the possible confounders in the studies.

Current evidence suggests that maternal OCP exposure increases the risk for respiratory allergic diseases (asthma and rhinitis) in the offspring, but not for eczema. Given the few studies included, future larger, prospective studies that control for important confounders are needed to verify our findings.
The effect of exercise as an intervention for women with polycystic ovary syndrome
Authors: dos Santos Isis Kelly , Ashe Maureen C. , Cobucci Ricardo Ney , Soares Gustavo Mafaldo , de Oliveira Maranhão Tecia Maria , Dantas Paulo Moreira Silva
Published: April 2020

Background:

Polycystic ovary syndrome (PCOS) affects reproductive-aged women and is associated with increased prevalence of serious clinical problems including: reproductive implications, metabolic dysfunction, and cardiovascular risk. Physical activity offers several health benefits for women with PCOS. The aim of this systematic review was to synthesize evidence on the effect of different types of exercise on reproductive function and body composition for women with PCOS.

Methods:

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) following recommended review methods. We searched 6 databases: Cumulative Index of Nursing and Allied Health Literature; Embase; MEDLINE (via Ovid); PubMed; Sport Discus; and Web of Science; and we developed search strategies using a combination of Medical Subject Headings terms and text words related to exercise interventions for women with PCOS. There was no restriction on language or publication year. The search was conducted on April 16, 2019 and updated on November 15, 2019. Two authors independently screened citations, determined risk of bias and quality of evidence with Grading of Recommendations Assessment, Development and Evaluation. We conducted meta-analyses following recommended guidelines, and report results using standardized mean difference (SMD).

Results:

Ten RCTs (n = 533) were included in this review. Studies tested the following interventions: aerobic, resistance, and combined (aerobic/resistance) training programs. Most studies were small (average 32, range 15–124 participants), and of relatively short duration (8–32 weeks). There was high heterogeneity for outcomes of reproductive function (menstrual cycle, ovulation, and fertility). We noted low certainty evidence for little to no effect of exercise on reproductive hormones and moderate certainty evidence that aerobic exercise reduced body mass index (BMI) in women with PCOS: BMI SMD −0.35, 95% confidence interval −0.56 to −0.14, P = .001.

Conclusion:

For women with PCOS, evidence is limited to discern the effect of exercise on major health outcomes (e.g., reproductive function). There is moderate certainty evidence that aerobic exercise alone is beneficial for reducing BMI in women with PCOS. Future studies should be conducted with longer duration, larger sample sizes, and should provide detailed information on menstrual cycle and fertility outcomes.

PROSPERO Systematic review registration: 2017 CRD42017058869.
The efficacy of transcranial alternating current stimulation for treating post-stroke depression
Authors: Wang Hongxing , Zhang Wenrui , Zhao Wenfeng , Wang Kun , Wang Zu , Wang Li , Peng Mao , Xue Qing , Leng Haixia , Ding Weijun , Liu Yuan , Li Ning , Dong Kai , Zhang Qian , Huang Xiaoqin , Xie Yunyan , Chu Changbiao , Xue Sufang , Huang Liyuan , Yao Hui , Ding Jianping , Zhan Shuqin , Min Baoquan , Fan Chunqiu , Zhou Aihong , Sun Zhichao , Yin Lu , Ma Qingfeng , Baskys Andrius , Jorge Ricardo E. , Song Haiqing
Published: April 2020

Background:

The treatment of post-stroke depression (PSD) with anti-depressant drugs is partly practical. Transcranial alternating current stimulation (tACS) offers the potential for a novel treatment modality for adult patients with PSD. In this study, we will assess the efficacy and safety of tACS for treating PSD and explore its effect on gamma and beta-oscillations involving in emotional regulation.

Methods:

The prospective study is an 8-week, double-blind, randomized, placebo-controlled trial. Seventy eligible participants with mild to moderate PSD aged between 18 years and 70 years will be recruited and randomly assigned to either active tACS intervention group or sham group. Daily 40-minute, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), and an additional 4-week observational period (week 8) will be followed up. The primary outcome is the proportion of participants having an improvement at week 8 according to the Hamilton Depression Rating Scale 17-Item (HAMD-17) score, including the proportion of participants having a decrease of ≥ 50% in HAMD-17 score or clinical recovery (HAMD-17 score ≤ 7). Secondary outcomes include neurological function, independence level, activities of daily living, disease severity, anxiety, and cognitive function. The exploratory outcomes are gamma and beta-oscillations assessed at baseline, week 4, and week 8. Data will be analyzed by logistical regression analyses and mixed-effects models.

Discussion:

The study will be the first randomized controlled trial to evaluate the efficacy and safety of tACS at a 77.5-Hz frequency and 15-mA current in reducing depressive severity in patients with PSD. The results of the study will present a base for future studies on the tACS in PSD and its possible mechanism.

Trial registration number: NCT03903068, pre-results.
Contradictions between DAPT and PRECISE-DAPT scores with the severity of coronary lesion in acute coronary syndrome
Authors: Bi Sisi , Zhao Yue , Peng Qingling , Liu Wenxue , Zhang Guogang , Zhang Chenglong
Published: April 2020

This study aimed to identify the correlation of contradiction between DAPT score and PRECISE-DAPT score with the severity of coronary lesion in acute coronary syndromes (ACS).

In total, 458 patients with ACS after a percutaneous coronary intervention (PCI) who had tolerated 1-year uneventful dual antiplatelet therapy (DAPT) were enrolled and divided into groups based on the Gensini score, number of stenosed vessels, and left main (LM) disease. Both DAPT score and PRECISE-DAPT score were calculated and the proportion of patients receiving conflicting recommendations from each score was compared among the groups.

DAPT score as well as the proportion of patients with DAPT score ≥2 were associated with the Gensini score and the number of stenosed vessels. Similarly, PRECISE-DAPT score as well as the proportion of patients with PRECISE-DAPT score ≥25 were associated with the Gensini score and the number of stenosed vessels. The proportion of patients with DAPT score ≥2 along with PRECISE-DAPT score ≥25 were associated with Gensini score, but they had no significant association with the number of stenosed vessels (P = .006 and P = .075, respectively). None of those aforementioned items were associated with LM disease.

The inconsistencies of DAPT scores and PRECISE-DAPT scores are frequent and associated with the severity of coronary disease, represented by the Gensini score. Appropriate clinical decisions should be individualized.
Clinicopathological risk factors in the light of the revised 2018 International Federation of Gynecology and Obstetrics staging system for early cervical cancer with staging IB
Authors: Zeng Jing , Qu Pengpeng , Hu Yuanjing , Sun Peisong , Qi Ji , Zhao Guiling , Gao Yan
Published: April 2020

To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer on the survival of patients who underwent radical hysterectomy for 2009 FIGO stage IB carcinomas.

We retrospectively identified and reviewed 251 patients treated with radical hysterectomy for 2009 FIGO stage IB cervical carcinomas from January 2011 to December 2016. The re-staged IB cohort consisted of 2018 FIGO stage IB1 (tumor size <2 cm), IB2 (2–3.9 cm), IB3 (≥4 cm), and IIIC1p (any pelvic nodal metastasis) cervical cancer. The univariate log-rank test and multivariate Cox regression models were performed for all potential clinic pathological risk factors based on cancer stage.

On re-staging the 251 patients with 2009 FIGO stage IB using the 2018 FIGO staging system, 96 patients (38.2%) had stage IB1, 109 patients (43.4%) had stage IB2, 28 patients (11.2%) had stage IB3, and 18 patients (7.2%) had stage IIIC1p. The 5-year overall survival (OS) rates of patients with 2018 FIGO stage IB1, IB2, IB3, and IIIC1p were 97.9%, 92.7%, 78.6%, and 61.1%, respectively. The 5-year progression-free survival rates were 97.9%, 92.7%,63.7%, and 20.8%, respectively. Factors significantly affecting OS and disease-free survival were 2018 FIGO stage≥IB3, histologic grade 2–3, and lymph node involvement.

The revised 2018 FIGO staging system seemed to accurately reflect the survival rate, with a distinct statistical tendency for poorer 5-year disease-free survival and OS rates with increasing stage. Women with positive lymph nodes in this classification were classified as having stage IIIC disease, which can achieve more realistic survival results than the previous staging system. The prognostic discrimination of histologic grade should be considered when revising the staging system in the future.
Changes in immune indicators and bacteriologic profile were associated with patients with ventilator-associated pneumonia
Authors: Yao Jie , Guan Shihe , Liu Zhou , Li Xin , Zhou Qiang
Published: April 2020

The aim of this study is to explore and identify ventilator-associated pneumonia (VAP)-related prognostic immune factors and further detect the drug-resistant pathogens to establish the theoretical guidance for clinical prevention and treatment strategies of VAP. A total of 478 patients using ventilator who were hospitalized in July 2014 to November 2016 in our hospital were enrolled in this study. About 103 patients with VAP (21.5%, 103/478) among 478 cases of patients using ventilator. Among the 103 patients with VAP, the distribution of pathogenic bacteria and drug resistance in patients with VAP were detected and analyzed. In the VAP group, 35 patients died and 43 patients had simultaneous sepsis. Compared with those of non-VAP group, the proportion of CD3+(P = .012), CD3+CD4+(P = .024) and CD8+CD28+(P = .017) T cells in VAP group increased significantly, which indicated more severe immune response. Multivariate regression model analysis revealed that tracheotomy of mechanical ventilation (P = .013), mechanical ventilation time ≥7 days (P = .02) and aspiration and reflux (P = .011) were independent risk factors associated with VAP. According to the results of bacterial culture and drug sensitivity test, rational selection of antibiotics and monitoring of patients within intensive care unit can effectively control the incidence of VAP and improve the prognosis of patients.
Predictive values of D-dimer for the long-term prognosis of acute ST-segment elevation infarction
Authors: Zhou Qi , Xue Yuzhou , Shen Jian , Zhou Wei , Wen Yi , Luo Suxin
Published: April 2020

D-dimer is a primary degradation product of cross-linked fibrin, and can be an effective diagnostic factor of venous thromboembolism. However, its prognostic role in patients with acute ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to investigate whether D-dimer has a predictive value for long-term prognosis in patients with STEMI.

We retrospectively enrolled 872 STEMI patients treated with primary percutaneous coronary intervention. Patients were divided into quartiles according to their admission D-dimer increased multiple, with the highest quartile (G4) (n = 219) defined as increased multiple ≧1.33, and the lowest quartile (G1) (n = 215) as increased multiple ≦0.33.

Compared with G1, higher in-hospital heart failure (40.2% vs 10.2%, P < .0001), malignant arrhythmia (14.2% vs 2.3%, P < .0001), and all-cause mortality (5.9% vs 0%, P < .0001) rates were observed in G4. After a follow-up period of 29 months, 84 patients had died. In the Cox multivariate analysis, a high admission D-dimer increased multiple (≧1.33) was found to be an independent predictor of all-cause mortality (hazards ratio: 2.53, 95% confidence interval: 1.02–6.26, P = .045).

Thus, there was an association between a high D-dimer level and the increase in in-hospital major adverse cardiovascular events, such as heart failure, malignant arrhythmias, and death. High D-dimer level was also an independent predictor of long-term all-cause mortality.
Discriminating malignant and benign clinical T1 renal masses on computed tomography
Authors: Uhlig Johannes , Biggemann Lorenz , Nietert Manuel M. , Beißbarth Tim , Lotz Joachim , Kim Hyun S. , Trojan Lutz , Uhlig Annemarie
Published: April 2020

The aim of this study was to discriminate malignant and benign clinical T1 renal masses on routinely acquired computed tomography (CT) images using radiomics and machine learning techniques.

Adult patients undergoing surgical resection and histopathological analysis of clinical T1 renal masses were included. Preoperative CT studies in venous phase from multiple referring centers were included, without restriction to specific CT scanners, slice thickness, or degrees of artifacts. Renal masses were segmented and 120 standardized radiomic features extracted. Machine learning algorithms were used to predict malignancy of renal masses using radiomics features and cross-validation. Diagnostic accuracy of machine learning models and assessment by independent blinded radiologists were compared based on the gold standard of histopathologic diagnosis.

A total of 94 patients met inclusion criteria (benign renal masses: n = 18; malignant: n = 76). CT studies from 18 different scanners were assessed with median slice thickness of 2.5 mm and artifacts in 15 cases (15.9%).

Area under the receiver-operating-characteristics curve (AUC) of random forest (random forest [RF], AUC = 0.83) was significantly higher compared to the radiologists (AUC = 0.68, P = .047). Sensitivity was significantly higher for RF versus radiologists (0.88 vs 0.80, P = .045), whereas specificity was numerically higher for RF (0.67 vs 0.50, P = .083).

Although limited by an overall small sample size and few benign renal tumors, a radiomic features and machine learning approach suggests a high diagnostic accuracy for discrimination of malignant and benign clinical T1 renal masses on venous phase CT. The presented algorithm robustly outperforms human readers in a real-life scenario with nonstandardized imaging studies from various referring centers.
Isolated stridor without any other sleeping breathing disorder diagnosed using drug-induced sleep endoscopy in a patient with multiple system atrophy
Authors: Heo Sung Jae , Kim Jung Soo , Lee Byung Joo , Park Donghwi
Published: April 2020

Rationale:

Multiple system atrophy (MSA) is a rare neurodegenerative disease characterized by Parkinsonism and autonomic dysfunction or cerebellar ataxia. MSA can be accompanied by stridor caused by laryngeal stenosis secondary to vocal cord dysfunction.

Patient concern:

A 60-year-old woman with MSA, complaining of difficulty in breathing during sleep. Her bed partner reported witnessing grunting-like sounds during sleep.

Diagnosis:

Isolated stridor without any other sleeping breathing disorder diagnosed using drug-induced sleep endoscopy (DISE) in a patient with MSA.

Interventions:

On polysomnography, there was no obstructive sleep apnea. Using DISE, abnormally adducted vocal cords during inspiratory respiration were identified, leading to a diagnosis of stridor. We prescribed positive airway pressure to resolve the stridor.

Outcome:

Our patient was also prescribed continuous positive airway pressure for the treatment of nocturnal stridor, and it is improved.

Lessons:

In summary, when MSA patients present with nocturnal stridor, it is important to evaluate the exact diagnosis and cause of stridor in patients by confirming the movement of vocal cords using DISE, as well as polysomnography.
Prevalence of osteoporosis in patients with type 2 diabetes mellitus in the Chinese mainland
Authors: Si Yuhao , Wang Cenyi , Guo Yang , Yin Heng , MA Yong
Published: April 2020

Background:

Osteoporosis, as a metabolic disease, has become one of the most rapidly growing complications of diabetes mellitus. Previously, we conducted a systematic review to report the estimated prevalence of osteoporosis among patients with type 2 diabetes mellitus (T2DM) from 2001 to 2016. However, some newer studies have been reported, and more potential risk factors for osteoporosis remain controversial and vague. Therefore, the presented review is tailored to synthesize available evidence regarding the pooled prevalence and related risk factors of osteoporosis among T2DM patients in mainland China.

Methods:

Both cross-sectional study and cohort study reporting on the prevalence of osteoporosis among patients with T2DM in mainland China, published in Chinese or English, will be considered for inclusion. Records from 4 English databases and 2 Chinese databases will be retrieved from their inceptions to March 2020. The process of study selection, data extraction, and methodologic quality assessment will be independently executed by 2 reviewers. The pooled prevalence of osteoporosis and the prevalence in the exposed and unexposed groups for each potential risk factor will be calculated by the software Stata version 12.0.

Results:

The current systematic review and meta-analysis will provide more precise prevalence rates and associated risk factors of osteoporosis among people with T2DM in mainland China.

Conclusion:

The study will offer high-quality and explicit evidence for assisting diabetic patients to prevent osteoporosis in mainland China.

OSF Registration:

DOI 10.17605/OSF.IO/5ZKJ6.
Efficacy and safety of the injection of the traditional Chinese medicine salviae miltiorrhizae and ligustrazine hydrochloride for the treatment of perioperative period of fracture
Authors: Xie Jialong , Chen Shichun , Ding Shaobo
Published: April 2020

Background:

The injection of the traditional Chinese patent medicine salviae miltiorrhizae and ligustrazine hydrochloride injection (SMLHI) has been widely used in treatment of various diseases such as angina pectoris or ischemic stroke in China. We aim to evaluate the efficacy and safety of SMLHI for the treatment of perioperative period of fracture.

Methods:

A systematic literature search was performed in seven medical databases from their inception until February 2019. 16 studies with randomized controlled trials, totaling 1589 patients, were included in this meta-analysis. The included studies were assessed by the cochrane risk of bias and analyzed by Review Manager 5.3 software.

Results:

The meta-analysis showed that SMLHI for the treatment of perioperative period of fracture was significantly better compared with the control group in terms of the total effective rate. The result showed that SMLHI could significantly reduce the risk of deep vein thrombosis and inflammatory cytokines. Furthermore, the result showed that SMLHI could significantly improve the coagulation function indexes such as prothrombin time, plasma fibrinogen and D-Dimer (P < .0001).

Conclusions:

This meta-analysis demonstrated that SMLHI may be more effective and safe for the treatment of perioperative period of fracture. However, further and higher quality randomized controlled trials are required to prove treatment outcome.
Evaluation of the development of the posterior fossa in normal Chinese fetuses by using magnetic resonance imaging
Authors: Ye Jintang , Rong Rong , Dou Yanbin , Jiang Jian , Wang Xiaoying
Published: April 2020

The posterior fossa is an important brain structure containing the cerebellum, cerebral ventricle, and cistern. Early evaluation of the cerebellar structure and function may be valuable for early detection of fetal deformities. At present, no normal value for the fetal posterior fossa has been established yet. This study is aimed to investigate the development of the posterior fossa in normal Chinese fetuses by using magnetic resonance imaging (MRI).

Pregnant women who need MRI scan were enrolled in our Hospital between January 2012 and December 2014. The fetal supero-inferior diameter (SID), anterio-posterior diameter (APD), cerebellar vermis area, cerebellar width (CW), cerebellar volume (CV), superior cerebellar cistern width, and cerebellomedullary cistern width were measured using MRI. Pearson's correlation analysis was used to detect the relationship between those parameters and gestational age. A regression analysis was performed for all parameters.

A total of 92 participants were retrospectively enrolled finally. The results indicated SID, APD, cerebellar vermis area, CW, and CV were positively associated with gestational age, while no significant correlation was found between the superior cerebellar cistern width and cerebellomedullary cistern width and gestational age. Each equation was established.

Our study demonstrated that MRI has the advantages over ultrasound imaging for prenatal evaluation of the fetal posterior fossa with multiple views. Normal value of the posterior fossa of Chinese fetuses was established in this study.
The functional effect of 3D-printing individualized orthosis for patients with peripheral nerve injuries
Authors: Chae Dong-Sik , Kim Da-Ham , Kang Kyung-Yil , Kim Doo-Young , Park Si-Woon , Park Sung-Jun , Kim Jae-Hyung
Published: April 2020

Rationale:

In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries.

Patients concerns:

In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury.

Diagnosis:

Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography.

Interventions:

Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis.

Outcomes:

For hand function evaluation, we assessed the Jebsen–Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function.

Lessons:

The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.
Impact of Epstein-Barr virus coinfection in Mycoplasma pneumoniae pneumonia
Authors: Xu Yingchun , Li Shuxian , Liu Jinling , Zhou Junfen , Jin Fang , Chen Xiaoyang , Wang Yingshuo , Jiang Yuan , Chen Zhimin
Published: April 2020

Mycoplasma pneumoniae (MP) is one of the most common pathogens of respiratory infection in children, while Epstein-Barr virus (EBV) infection is usually subclinical in immunocompetent children. Although single MP infection is common enough, MP and EBV coinfection have received little attention. Especially, the pathogenic role of EBV in lung when coinfection with MP, has not been clarified. The purpose of this study was to investigate the impact of EBV on MP pneumonia (MPP) in hospitalized children. We retrospectively reviewed the clinical data of MPP children who underwent screening for EBV by polymerase chain reaction in bronchoalveolar lavage fluid during hospitalization in 2014. Of total 147 patients, 68 patients were in the MP group and 79 were in the MP/EBV coinfection group. We found longer fever duration and higher CRP, IgA, IgG, interleukin-2 (IL-2), percentage of peripheral neutrophils levels, higher incidence of pulmonary consolidation and percentage of refractory MPP in coinfection group, when compared to those in MP group. In ROC curve analysis, IL-2 was useful for differentiating patients with coinfection from those with MP infection. Logistic regression analysis showed that the IL-2 ≥ 3.35 pg/ml (OR = 3.677) was a significant predictor regarding to MP/EBV coinfection. In conclusion, coinfection of EBV and MP poses a higher risk for prolonged symptoms. IL-2 could be used as a good predictor of coinfection.