bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostate cancer awareness and screening practice among Kenyan men
Authors: Erena Asfaw N. , Shen Guanxin , Lei Ping
Published: April 2020

Despite globally increased awareness and widespread availability of screening tools, little is known about prostate cancer (PCa) awareness and screening practices in Kenya. To assess PCa awareness and screening practice among Kenyan men (age: 15–54 years), a cross-sectional study was carried out using Kenya Demographic Health Survey (KDHS 2014) data. A subsample of 12 803 men was taken and analyzed using SPSS version 22. Overall, 7926 (61.9%) men were aware of PCa. Three hundred eleven (3.9%) men who were aware of PCa reported ever screening for PCa. A strong association was found by crude and adjusted logistic regression analysis between men’s awareness and age categories [age: 25–34 years, 95% confidence interval (CI) = 1.32–1.73, P < 0.001; age: 35–44 years, 95% CI = 1.51–2.08, P < 0.001; age: 45–54 years, 95% CI = 1.70–2.44, P < 0.001] compared with men in the age category of 15–24 years. Similarly, an association was observed in men with insurance coverage with awareness (95% CI = 1.35–1.76, P < 0.001) and with screening practice (95% CI = 1.35–2.37, P < 001). Compared with illiterate men, men with primary education (95% CI = 1.82–2.72, P < 001), secondary education (95% CI = 3.84–5.89, P < 001), and higher education (95% CI = 9.93–17.38, P < 0.001) were more likely to be aware of PCa. Sociodemographically, richer (95% CI = 1.36–1.79, P < 0.001) and richest (95% CI = 1.62–2.27, P < 0.001) men were more likely to be aware of PCa than those in the poorest wealth index category. The awareness of Kenyan men of PCa is good. However, the PCa screening practice among Kenyan men is very poor. Hence, health promotion in a PCa screening program should be strengthened to improve public understanding about PCa, available screening tests, and the importance of early PCa screening.
CONTRACTILE OPTIC DISK AND PERIPHERAL AVASCULAR RETINA IN A CASE OF MORNING GLORY DISK ANOMALY
Authors: Rajendran Anand , Kumar Jayant
Published: April 2020

Purpose:

To report a rare case of morning glory disk anomaly with a contractile optic disk and a peripheral avascular retina along with detailed spectral domain optical coherence tomography characteristics of the contractions.

Methods:

Serial fundus photographs and optical coherence tomography images were taken to study the characteristics of optic disk contractions. Fundus fluorescein angiography was performed to delineate the peripheral avascular retina in the same eye.

Results:

A 9-year-old boy presented to us with morning glory disk anomaly in the left eye. He had contractile motions of the optic disk around two to three times in a minute, with each contraction lasting for 4 seconds to 5 seconds. Serial spectral domain optical coherence tomography images could depict an anterior contraction of the optic disk along with the surrounding peripapillary staphyloma with no evidence of any subretinal fluid. Fundus examination of the left eye also suggested the presence of an avascular retina temporally, which was confirmed on fundus fluorescein angiography.

Conclusion:

Our report provides detailed spectral domain optical coherence tomography images through the optic disk in morning glory disk anomaly during various phases of optic disk contractions. It also presents a second rare association of a peripheral avascular retina in the case.
Transcorneal Cryotherapy and Descemet Membrane Endothelial Keratoplasty to Treat Epithelial Downgrowth and Corneal Decompensation After Cataract Surgery
Authors: Diel Ryan J. , Morrow Nicole C. , Jiang Lai , Huffman James M. , Greiner Mark A.
Published: April 2020

Purpose:

Epithelial downgrowth is a vision-threatening complication of intraocular surgery or penetrating ocular trauma, and although various therapeutic interventions have been performed to treat this disease, success has been limited. We present a case of corneal decompensation secondary to epithelial downgrowth after uncomplicated clear corneal cataract surgery in the left eye, treated successfully with sequential transcorneal cryotherapy to destroy epithelial cell nests followed by Descemet membrane endothelial keratoplasty (DMEK) to restore corneal clarity and vision.

Methods:

We applied a transcorneal cryotherapy probe using a double freeze-thaw technique at −80°C to the entire cornea, with care taken to spare the limbus except at the superior temporal quadrant overlying the clear corneal incision where treatment was applied intentionally. The same procedure was performed 2 weeks later to ensure complete ablation of epithelial nest cells. Uncomplicated DMEK surgery using standard technique was performed 1 week later to restore corneal clarity.

Results:

Visual acuity at presentation was 20/40. Endothelial cell densities were 2138 cells/mm2 (22% loss) and 1720 cells/mm2 (37% loss) at 3- and 12-months after DMEK, respectively. Two years after surgery, the best-corrected visual acuity remained 20/20 and the patient had no evidence of recurrence or limbal stem cell deficiency.

Conclusions:

The use of sequential cryotherapy as a targeted intervention to destroy invasive corneal epithelial cells followed by staged DMEK surgery to replace damaged corneal endothelium was, in this case, an effective treatment for endothelial decompensation secondary to epithelial downgrowth and may be a potential alternative for the management of this disease.
Topical Voriconazole as Supplemental Treatment for Acanthamoeba Keratitis
Authors: Musayeva Aytan , Riedl Jana C. , Schuster Alexander K. , Wasielica-Poslednik Joanna , Pfeiffer Norbert , Gericke Adrian
Published: April 2020

Purpose:

Voriconazole was shown to inhibit ergosterol synthesis in various acanthamoeba species. The purpose of this study was to evaluate the clinical outcome of treatment with supplemental topical voriconazole in patients with acanthamoeba keratitis (AK).

Methods:

All patients who had been treated for AK with voriconazole 1% drops in conjunction with topical first-line antiacanthamoeba therapy composed of polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% (Brolene) between November 2014 and August 2017 at the Department of Ophthalmology, University Medical Center Mainz, were included. The main outcomes were treatment failure and recurrence rate. Secondary outcomes were visual acuity, need for keratoplasty, and presence of adverse reactions.

Results:

Twenty-eight eyes of 28 patients with AK, whose treatment had included topical voriconazole, were identified (12 men, 16 women, mean age: 41.7 ± 16.3 years), and 26 of them could be tracked for at least 3 months after cessation of therapy. Resolution of infection under therapy was seen in all eyes, and only one of 26 (3.85%) had a relapse after the therapy had been stopped. Best-corrected visual acuity improved during therapy. Keratoplasty because of central corneal scarring was scheduled in 5 of 26 patients (19.2%) after the pharmacological therapy had been stopped. Five of 26 patients (19.2%) reported on stinging or burning sensation after application of voriconazole 1% drops.

Conclusions:

Topical voriconazole 1% combined with first-line therapy composed of polyhexamethylene biguanide 0.02% and propamidine isethionate 0.1% appears to be an effective option with minor side effects for the treatment of AK.
Descemet Membrane Endothelial Keratoplasty: Development of Contrast Sensitivity and Color Vision in Patients With Fuchs Endothelial Corneal Dystrophy
Authors: Bayyoud Tarek , Wilhelm Helmut , Gelisken Faik , Martus Peter , Bartz-Schmidt Karl Ulrich , Thaler Sebastian
Published: April 2020

Purpose:

To assess the developments in contrast sensitivity, color vision, and subjective perception after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:

Included in this study were pseudophakic, unilateral DMEK patients with bilateral FECD having a follow-up period of 6 months (n = 23). The mean age at surgery was 70 years (range: 52–81 years). Pseudophakic eyes without history of other ocular pathology or surgery served as a control (n = 10). Pelli–Robson contrast sensitivity and Panel-D15 color vision tests were used. Best-corrected visual acuity, modified visual functioning questionnaire-25, central corneal thickness, and endothelial cell density were assessed. We visualized the subjective impression of patients with bilateral FECD after unilateral DMEK in a subgroup using Photoshop CS6.

Results:

Contrast sensitivity improved significantly from 1.35 ± 0.26 to 1.64 ± 0.17 (P = 0.002; control eyes: 1.92 ± 0.09). No difference in the color vision error score was observed for preoperative and postoperative eyes (P = 0.063). The best-corrected visual acuity improved significantly after surgery (P = 0.001). The average values in the Logarithm of the Minimum Angle of Resolution were 0.59 ± 0.42 preoperatively and 0.1 ± 0.10 postoperatively (control eyes: 0.01 ± 0.03). Examinations revealed a decrease of the central corneal thickness and endothelial cell density after surgery (P = 0.001; P = 0.001, respectively). Scores in the general and the driving questionnaire were significantly higher after surgery (P = 0.001; P = 0.005, respectively).

Conclusions:

This study showed significant improvement in subjective patient satisfaction and contrast sensitivity. Spontaneous subjective color vision improvement might be explained by significantly improved contrast sensitivity. Contrast sensitivity might be considered as a parameter in preoperative decision-making and evaluation of surgical outcome.
Computational Model of Sclerotic Scatter
Authors: Johnston Fiona , Ho Arthur , Coroneo Minas
Published: April 2020

Purpose:

A clinical examination technique to detect pathology within the anterior eye is known as “sclerotic scatter” (SS). Its propagation pathway has not been thoroughly investigated. Although conventionally theorized to occur by “total internal reflection” (TIR) within the cornea, existing data suggest that this may be an incomplete explanation.

Methods:

An anterior eye model representative of a human eye has been constructed using nonsequential ray tracing (OpticStudio 18.1). Three generations of the model were constructed to support the analyses of the pathway of light in SS. A design of experiment methodology involving the key parameters was used to determine the slit-lamp setup for optimum clinical visualization.

Results:

Most of the light directed into the temporal limbus in SS is lost (52%) into the sclera or reemitted back to the clinician. Only 0.006% of light that transits the central cornea undergoes TIR off the anterior cornea and more significantly 0.000125% off the posterior cornea. The optimal slit-lamp setup parameters to maximize the clinician's visualization are also summarized.

Conclusions:

The propagation of light within SS primarily does not occur by TIR off the posterior cornea but rather the direct transcameral propagation of light. SS also represents an inefficient usage of light, with approximately half of the light creating a potential glare source for clinicians. We have formulated a recommended set of parameters for the slit-lamp setup to maximize clinical visualization. We also describe the transcameral pathways involved in SS that create a corneal “backlighting” effect. Almost a century after Graves original description, the optics of this phenomenon are described here.
Gastrointestinal and liver manifestations in patients with COVID-19
Authors: Lee I-Cheng , Huo Teh-Ia , Huang Yi-Hsiang
Published: April 2020

As the outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread over the world, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Besides typical respiratory symptoms and signs of COVID-19, digestive symptoms and liver injury have been frequently reported during the course of the disease. In this review, we summarized the recent studies reporting of gastrointestinal and liver manifestations during the course of COVID-19. Digestive symptoms, including anorexia, nausea, vomiting, and diarrhea, are not uncommon in patients with COVID-19, and in some cases digestive symptoms may occur in the absence of any respiratory symptoms. Furthermore, SARS-CoV-2 could be detected in the stool of infected patients, implicating the possibility of fecal–oral transmission. Attention should also be paid to monitor liver function during the course of COVID-19, especially in patients with higher disease severity.
The Effect of Forced Cough to Minimize Pain and Discomfort at the Time of Colposcopy-Guided Cervical Biopsy
Authors: Kuhn Theresa , Ukazu Adanna , Strickland Pamela Ohman , Roche Natalie , Taveras Yanille , Kovalenko Olga , Pompeo Lisa , Einstein Mark
Published: April 2020

Objective

The aim of the study was to determine whether forced cough during colposcopy-guided cervical biopsy affected pain and anxiety levels.

Materials and Methods

The study was conducted at the University Hospital (Newark, NJ) Ambulatory Care Center from December 2016 to June 2018 and evaluated 110 patients at the time of a colposcopy-guided cervical biopsy. Study patients were randomized to either cough or no cough group during the biopsy procedure. Pain level was assessed using a visual analog pain scale before, during, and immediately after a colposcopy-guided cervical biopsy. Study patients also completed a standardized anxiety survey before and after the procedure. T tests, Pearson χ2, or Cochran-Mantel-Haenszel were used to compare baseline characteristics between the cough and no cough groups. Multivariate linear regression analysis was used to identify potential confounders and then compare pain levels across both groups.

Results

There was no statistically significant difference in pain scores between the cough and no cough group when analyzed for each demographic variable even when confounders were accounted for. The anxiety scores for both study groups before and after the procedure were similar and not significantly reduced.

Conclusions

We observed a trend that cough reduced pain associated with the colposcopy-guided cervical biopsy but did not reach statistical significance. A similar outcome was observed in anxiety level, where anxiety was reduced in the cough group but was not statistically significant as compared with the no cough group. Further studies are necessary to assess various modalities in reducing pain and anxiety associated with colposcopy-guided cervical biopsy.
Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines
Authors: Egemen Didem , Cheung Li C. , Chen Xiaojian , Demarco Maria , Perkins Rebecca B. , Kinney Walter , Poitras Nancy , Befano Brian , Locke Alexander , Guido Richard S. , Wiser Amy L. , Gage Julia C. , Katki Hormuzd A. , Wentzensen Nicolas , Castle Philip E. , Schiffman Mark , Lorey Thomas S.
Published: April 2020

Objective

The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities recommend 1 of 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, 5-year return to regular screening) based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for the many different combinations of current and recent past screening results. This article supports the main guidelines presentation
1
by presenting and explaining the risk estimates that supported the guidelines.

Methods

From 2003 to 2017 at Kaiser Permanente Northern California (KPNC), 1.5 million individuals aged 25 to 65 years were screened with human papillomavirus (HPV) and cytology cotesting scheduled every 3 years. We estimated immediate and 5-year risks of CIN 3+ for combinations of current test results paired with history of screening test and colposcopy/biopsy results.

Results

Risk tables are presented for different clinical scenarios. Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. The immediate and 5-year risks of CIN 3+ used to decide clinical management are shown.

Conclusions

The new risk-based guidelines present recommendations for the management of abnormal screening test and histology results; the key risk estimates supporting guidelines are presented in this article. Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables.
A Study of Partial Human Papillomavirus Genotyping in Support of the 2019 ASCCP Risk-Based Management Consensus Guidelines
Authors: Demarco Maria , Egemen Didem , Raine-Bennett Tina R. , Cheung Li C. , Befano Brian , Poitras Nancy E. , Lorey Thomas S. , Chen Xiaojian , Gage Julia C. , Castle Philip E. , Wentzensen Nicolas , Perkins Rebecca B. , Guido Richard S. , Schiffman Mark
Published: April 2020

Introduction

The 2019 ASCCP Risk-Based Management Consensus Guidelines include recommendations for partial human papillomavirus (HPV) genotyping in management of abnormal cervical cancer screening results. The guidelines are based on matching estimates of cervical intraepithelial neoplasia (CIN) 3+ risk to consensus clinical action thresholds. In support of the guidelines, this analysis addresses the risks predicted by individual identification of HPV 16 and HPV 18.

Methods

Risk estimates were drawn from a subset of women in the Kaiser Permanente Northern California screening program, whose residual cervical specimens were HPV typed as part of the HPV Persistence and Progression study. We calculated risk of CIN 3+ to assess how identification of HPV 16, HPV 18, or 12 other “high-risk” HPV types would influence recommended clinical management of new abnormal screening results, taking into account current cytologic results and recent screening history. Immediate and/or 5-year risks of CIN 3+ were matched to clinical actions identified in the guidelines.

Results

Identification of HPV 16 at the first visit including HPV testing elevated immediate risk of diagnosing CIN 3+ sufficiently to mandate colposcopic referral even when cytology was Negative for Intraepithelial Lesions or Malignancy and to support a preference for treatment of cytologic high-grade squamous intraepithelial lesion. HPV 18 less clearly elevated CIN 3+ risk.

Conclusions

Identification of HPV 16 clearly mandated consideration in clinical management of new abnormal screening results. HPV 18 positivity must be considered as a special situation because of established disproportionate risk of invasive cancer. More detailed genotyping and use beyond initial management will be considered in guideline updates.
High GJB2 mRNA expression and its prognostic significance in lung adenocarcinoma: a study based on the TCGA database
Authors: Tang Yun , Zhang You-Jing , Wu Zeng-Hong
Published: April 2020

Lung adenocarcinoma (LUAD), a form of lung cancer, is reported to cause first and second-order cancer morbidity to men and women in China, respectively. We assessed the mRNA expression of GJB2 in LUAD patients in our study, based on data acquired from the cancer genome atlas (TCGA) and so as to increase further knowledge into the biological pathways involved in LUAD pathogenesis related to GJB2.

Information on gene expression and comparing clinical data were recognized and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes is indicated by their connection with GJB2 expression.

Our study cohort included 265 (54.5%) female and 221 (36.0%) male patients. The scatter plot and paired plot showed the difference of GJB2 expression between normal and tumor samples (P < .01). Overall survival (OS) analysis demonstrated that LUAD with GJB2 -high had a more terrible prognosis than that with GJB2 -low (P < .01). Multivariate analysis with the cox proportional hazards model indicated that the expression of Cx26 (HR: 1.00; 95%CI: 1.00–1.01; P = .041) and stage (HR: 1.95; 95%CI: 1.23–3.09; P = .003) were independent prognostic factors for patients with LUAD. The GSEA results showed that cytosolic DNA sensing pathway, apoptosis, cytokine-cytokine receptor interaction, natural killer cell mediated cytotoxicity, regulation of actin cytoskeleton, toll-like receptor signaling pathway, small cell lung cancer and pathways in cancer are differentially enriched in GJB2 high expression phenotype.

Our study confirmed the significantly high levels of Cx26 expression in LUAD patients with several observed clinical features. GJB2 may be a potentially useful prognostic molecular biomarker of bad survival in LUAD, while further experimental ought to be performed to demonstrate the biologic effect of GJB2.
The prognostic value of the C-reactive protein to albumin ratio in cancer
Authors: Cui Xinhua , Jia Zhiqiang , Chen Dingchao , Xu Chunwei , Yang Peng
Published: April 2020

Background:

Previous studies have demonstrated that the C-reactive protein to albumin ratio (CAR) is correlated with the clinical outcomes of solid tumors. However, the available data have not been systematically evaluated. The objective of the present meta-analysis was to explore the prognostic value of the CAR in solid tumors.

Methods:

Eligible studies were identified from the PubMed, EMBASE and Web of Science electronic databases. The clinical characteristics, disease -free survival (DFS) /progression-free survival (PFS) and overall survival (OS) were extracted from the eligible studies. The pooled hazard ratios (HRs) and 95% confidence intervals were calculated with STATA 12.0 software. We also performed subgroup, meta-regression and sensitivity analyses.

Results:

In total, twenty-seven eligible studies including 10556 patients were enrolled in the present meta-analysis. The pooled HRs with 95% confidence intervals showed that the CAR was significantly associated with poor OS (HR = 1.95, 95% CI: 1.71–2.22) and DFS/PFS (HR = 1.82, 95% CI: 1.61–2.07) in patients with solid tumors. Although publication bias was found in the studies with regard to OS, a further trim and fill analysis revealed that the adjusted HR was 1.82 (95% CI: 1.69–1.96), which was close to the original HR. Subgroup analysis confirmed the CAR as a strong prognostic marker in patients with solid tumors, regardless of the tumor type, detection time, cut-off value, sample size and area.

Conclusion:

Our meta-analysis indicated that a high CAR might be an unfavorable prognostic marker for OS and DFS/PFS in patients with solid tumors.
Effects of anodal transcranial direct current stimulation over the contralesional hemisphere on motor recovery in subacute stroke patients with severe upper extremity hemiparesis
Authors: Lee Stephanie Hyeyoung , Kim Won-Seok , Park Jihong , Kim Junsik , Paik Nam-Jong
Published: April 2020

Introduction:

Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment.

Methods and analysis:

We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.

The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index.

Discussion:

Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis.

Ethics and Dissemination:

The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.
Clinical efficacy and safety of Danhong injection for the treatment of chronic heart failure
Authors: Han Lihua , Wang Chuan , Yao Dongfeng , Wang Bin , Zhang Zhen , Liu Jiping
Published: April 2020

Background:

Danhong injection (DHI) has been widely in the treatment of chronic heart failure (CHF) in China; however, there is not enough clinical evidence DHI for treating CHF.

Methods:

Two researchers will search literatures of DHI for CHF in databases. Extracted data are analyzed with Review Manager 5.3 software. The selected studies should be conducted quality evaluation, forest plots and funnel plots will be run by RevMan5.3.

Results:

This systematic review validates the clinical efficacy and safety of DHI in the treatment of CHF through the analysis of New York Heart Association functional classification, left ventricular ejection fraction, left ventricular end-diastolic dimension, cardiac output, brain natriuretic peptide, adverse events.

Conclusions:

This systematic review will be provided a rational clinical evidence to evaluate the effectiveness and safety of DHI for the treatment of CHF.

Registration Number:

PROSPERO CRD42019144686.
Correlation among high salt intake, blood pressure variability, and target organ damage in patients with essential hypertension
Authors: Cai Wei , Lang MingJian , Jiang XiaoBo , Yu Qian , Zhou Congliang , Zou Wenshu , Zhang Xiaohua , Lei JianGuo
Published: April 2020

Background:

Essential hypertension is a multifactorial disease, which is affected by genetic and environmental factors, and can cause diseases such as cerebrovascular disease, heart failure, coronary heart disease, and chronic renal failure. High salt intake is a risk factor for hypertension, stroke, and cardiovascular disease. Blood pressure variability (BPV) is a reliable independent predictor of cardiovascular events and death. At present, there are few studies about the correlation among high salt intake, BPV, and target organ damage (TOD) in patients with hypertension.

Objective:

The purpose of this study is to compare 24-hour urine sodium excretion, BPV, carotid intima–media thickness, left ventricular mass index, and serum creatinine or endogenous creatinine clearance rate. To clarify the relationship between high salt load and BPV and TOD in patients with hypertension.

This study is a cross-sectional study. It will recruit 600 patients with essential hypertension in the outpatient and inpatient department of cardiovascular medicine of Chengdu Fifth People's Hospital. Researchers will obtain blood and urine samples with the patient's informed consent. In addition, we will measure patient's blood pressure and target organ-related information.

Trial registry:

The study protocol was approved by the Chengdu Fifth People's Hospital. Written informed consent will be obtained from all the participants. The trial was registered in the Chinese Clinical trial registry, ChiCTR2000029243. This trial will provide for the correlation among high salt intake, BPV, and TOD in patients with essential hypertension.
Distinguishment of parasite-infected children from pediatric inpatients with both eosinophilia and effusion
Authors: Miao Ruixue , Zhu Yu , Wang Zhiling , Luo Shuanghong , Wan Chaomin
Published: April 2020

Patients with both serous effusion and eosinophilia are rarely reported and geographically distributed; their early diagnosis is difficult.

According to the ultimate diagnosis, patients (≤14 years) in West China Second hospital with serous effusion and eosinophilia were divided into two groups including a parasitic group and a non-parasitic group. Clinical data were collected and analyzed between the two groups. Subsequently, significant measurement indicators were evaluated by receiver operating characteristic (ROC) curve to explore the optimal cut-off points for the most appropriate sensitivity and specificity.

A total of 884 patients were diagnosed with serous effusion and 61 of them displayed co-morbidity with eosinophilia during enrolled time. Among 61 patients, 34 patients had parasitic infection and 27 had non-parasitic diseases. There were statistical difference in effusion position, the levels of white blood cell count (WBC), eosinophil (EOS), EOS%, C-reactive protein (CRP) between parasitic group and non-parasitic group. ROC curve demonstrated that the areas under the curve of EOS count and EOS% were >80%, and the corresponding optimal cut-off values were 1.71 × 109/L and 25.6% for distinguishing between parasitic and non-parasitic infections in our patients.

This study provided a quantified index for potentially quick and convenient indicators of pediatric patients presenting with both eosinophilia and effusion. Eosinophils were helpful to improve the initial diagnosis with awareness of parasitic diseases. For the cases with EOS > 1.71 × 109/L or EOS% > 25.6%, parasitic infection should be considered and serological tests are recommended in our region.
Analysis of pre-chemotherapy WBC, PLT, monocyte, hemoglobin, and MPV levels in acute myeloid leukemia patients with WT1, FLT3, or NPM gene mutations
Authors: Merdin Alparslan , Dal Mehmet Sinan , Çakar Merih Kizil , Yildiz Jale , Ulu Bahar Uncu , Batgi Hikmetullah , Tetik Ayşegül , Seçilmiş Sema , Darçin Tahir , Şahin Derya , Bakirtaş Mehmet , Başçi Semih , Yiğenoğlu Tuğçe Nur , Baysal Nuran Ahu , İskender Dicle , Altuntaş Fevzi
Published: April 2020

Effects of mutations on AML (acute myeloid leukemia) patients have been an area of clinical interest. The aim of this study was to analyze pre-chemotherapy WBC (white blood cell), platelet, monocyte, hemoglobin, and mean platelet volume (MPV) levels in acute myeloid leukemia patients with Wilms tumor 1 (WT1), FMS-like tyrosine kinase 3 (FLT3), or nucleophosmin (NPM) gene mutations, attempting to detect and compare possible differences in these values.

The study included 71 patients with acute myeloid leukemia known to have WT1, FLT3, or NPM gene mutations. The patients were divided into 3 groups: FLT3-mutated AML patients without any accompanying known mutations other than WT1 at the time of diagnosis (Group 1), NPM-mutated AML patients without any accompanying known mutations other than WT1 at the time of diagnosis (Group 2), WT1-mutated AML patients with no other accompanying known mutations at the time of diagnosis (Group 3). We carried out intergroup comparisons of WBC, platelet (PLT), monocyte, hemoglobin, and MPV levels before chemotherapy.

There was a statistically significant difference between the groups in terms of WBC parameters (P = .001). There were no statistically significant differences between the groups with respect to hemoglobin, platelet, and monocyte levels.

Higher white blood cell counts could be observed in patients with FLT3-mutated AML.
Prognostic significance of lymphocyte monocyte ratio in patients with ovarian cancer
Authors: Cai Linrui , Song Yanlin , Zhao Xia
Published: April 2020

Background:

This study aimed to systematically assess the prognostic value of lymphocyte monocyte ratio (LMR) in patients with ovarian cancer through performing a meta-analysis.

Methods:

Web of Science, PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases were searched for potentially eligible studies. The baseline characteristics and relevant data were extracted. Hazard ratios with 95% confidence intervals (CIs) were combined to assess the prognostic value of LMR in patients with ovarian cancer.

Results:

Nine studies enrolling 2809 patients were included. The pooled hazard ratios of lower LMR for overall survival and progression free survival in patients with ovarian cancer were 1.71 (95% CI, 1.40–2.09) and 1.68 (95% CI, 1.49–1.88), respectively. Subgroup analysis and sensitivity analysis were also performed. No significant publication bias was found.

Conclusion:

Our results suggested that lower LMR was associated with poorer overall survival and progression free survival in patients with ovarian cancer. The findings may assist prognosis evaluation and future research on therapies based on modulating host immune response in ovarian cancer.
Is experience alone sufficient to diagnose developmental dysplasia of the hip without the bony roof (alpha angle) and the cartilage roof (beta angle) measurements?
Authors: Sari Ahmet Sinan , Karakus Ozgun
Published: April 2020

In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels.

Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography.

The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively.

The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons.

Level of evidence: 2.
Metformin and acupuncture for polycystic ovary syndrome
Authors: Gao Yang , Xu Suyun , Shen Yifeng , Liao Tingting , Hu Shiruo , Zhou Shan , Chen Qiu
Published: April 2020

Backgrounds:

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women and can lead to serious social burdens associated with various reproductive and metabolic abnormalities. Studies have demonstrated that metformin can reduce liver glucose in PCOS, lower testosterone levels and increase peripheral insulin sensitivity. There has been also evidence suggesting acupuncture may influence ovulation (release of the egg) by affecting levels of various hormones. We will conduct a systematic review and meta-analysis is to compare the efficacy and safety of metformin with or without acupuncture in PCOS.

Methods and analysis:

We will search publications from Web of Science, PubMed, Science Direct, Wan Fang Data Knowledge Service Platform, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), China National Knowledge Infrastructure (CNKI) and EMBASE, which should be published from inception to February 2020. Two researchers will independently perform the selection of the studies, data extraction, and synthesis. The Cochrane Risk of Bias Tool will be used to evaluate the risk of bias of the randomized controlled trials. Statistical analysis will be performed by using the Cochrane Review Manager (RevMan 5.3) software. The I
2 test will be used to identify the extent of heterogeneity. We will use the Egger funnel chart to evaluate possible publication biases, in addition, when possible we will perform a subgroup/meta-regression analysis. The strength of the evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results and conclusion:

This study will systematically evaluate the efficacy and safety of Metformin combined with acupuncture in the treatment of PCOS, thus providing evidence to the clinical application of this combination therapy. The results will be published in a peer-reviewed journal.
Effect of changes in serum levels of endogenous hydrogen sulfide on fracture healing
Authors: Liao Feng , Zhu Zongdong , Xiao Chengwei , Tan Bo , Tang Xiaoming , Wei Dan , Yuan Jiabin , Xiang Xuemei , Hu Jiang
Published: April 2020

Background:

Fracture is a common disease; many factors affect fracture healing. Recent studies have confirmed that hydrogen sulfide (H2S) plays an essential role in bone formation, but most of these studies are drawing conclusions based on animal experiment; whether H2S could promote fracture healing in patients is still unclear. We aim to investigate the change of serum H2S in fracture patients, and analyze its effort on fracture healing.

Methods:

This is a single-center, prospective cohort study. Patients with spinal or limb fracture will be recruited. Patient's serum and urine will be collected at baseline for examination (serum H2S, β-CTX, OC, PINP, 25-OH-VitD3, S-CTX, urinary calcium, and urinary creatinine). All patients will be followed-up for 24 months in outpatients settings, the image of X-ray or CT will be reviewed and fracture healing will be judged by 2 experienced orthopedic physicians. The difference in serum parameters especially H2S will be compared between patients with fracture healed within 9 months and those with fracture unhealed at 9 months.

Discussion:

Results of the trial could provide insight into influence of H2S on fracture healing.

Ethics and dissemination:

The study was approved by the ethics committee of School of Medicine UESTC & Sichuan Provincial People's Hospital Ethics Committee. All the participants will be asked to provide written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.
Effect of short-term intensive insulin therapy on α-cell function in patients with newly diagnosed type 2 diabetes
Authors: Zheng Hai-Lan , Xing Yan , Li Fan , Ding Wei , Ye Shan-Dong
Published: April 2020

The effect of intensive insulin therapy on hyperglucagonemia in newly diagnosed type 2 diabetes (T2DM), and its associations with β-cell function, has not been elucidated. This study assessed the effect of 12 weeks of intensive insulin therapy on hyperglucagonemia in newly diagnosed T2DM and its associations with β-cell function, with reference to the effects of 12 weeks of oral hypoglycemic agents (OHAs).

One hundred eight patients with newly diagnosed T2DM were enrolled from January 2015 to December 2015. The patients were randomly divided to receive, for 12 weeks, either intensive insulin therapy or OHAs. Meal tolerance tests were conducted at baseline before treatment (0 week), at 12 weeks (end of treatment), and 12 months after the initiation of treatment. The levels of glucagon, proinsulin, C-peptide (CP), and blood glucose were measured at timepoints 0, 30, and 120 minutes during the meal tolerance test.

Intensive insulin treatment was associated with a decrease in glucagon levels (at 0, 30, and 120 minutes) and proinsulin/CP, and an increase in the insulin-secretion index ΔCP30/ΔG30 and ΔCP120/ΔG120, at 12 weeks and 12 months during the follow-up, compared with the corresponding effects of OHAs. Intensive insulin therapy could reduce but failed to normalize glucagon levels at 12 weeks. There were no correlations between the change of percentages in total area under the curve of glucagon and other glycemic parameters (proinsulin/CP; ΔCP30/ΔG30; or ΔCP120/ΔG120). Patients who received intensive insulin therapy were more likely to achieve their target glycemic goal and remission, compared with those who received OHAs.

Short-term intensive insulin therapy facilitates the improvement of both β-cell and α-cell function in newly diagnosed T2DM mellitus. Decline of β-cell secretion and concomitant α-cell dysfunction may both be involved in the pathogenesis of T2DM.
Is serum vitamin B12 decrease a necessity for the diagnosis of subacute combined degeneration?
Authors: Cao Jie , Xu Shabei , Liu Chenchen
Published: April 2020

Background:

To determine the prevalence of subacute combined degeneration (SCD) patients with normal or elevated serum vitamin B12 level and to identify clinical characteristics of these patients.

Methods:

We searched PubMed, EMBASE, and Cochrane library, without language restriction up to June 2019 and included studies with SCD patients who were diagnosed with normal or elevated serum vitamin B12 levels. Meta-analysis was performed to estimate the prevalence of SCD in patients with normal or elevated serum vitamin B12 levels and compare the differences of clinical data between patients with low and no-low serum vitamin B12 level.

Results:

Six studies were included in our analysis, with a total number of 181 patients involved. The pooled proportion in patients with no-low serum vitamin B12 level was 31.0% (95% confidence interval [CI]: 22.5–40.8). There was no significant difference in the level of hemoglobin (Mean difference (MD): –3.05, 95% CI: –12.42 to 6.33. P = 0.52) and erythrocyte mean corpuscular volume (MD: –2.37, 95% CI: –11.17 to 6.43, P = 0.60) between SCD patients with no-low and those with low serum vitamin B12 levels. The meta-analysis showed that the functional disability rating scale on admission in patients with low serum vitamin B12 level was no worse than that with normal or elevated serum vitamin B12 level (MD: 0.29, 95% CI: –0.58 to 1.16, P = 0.51).

Conclusion:

Decreased level of serum vitamin B12 may not be a necessity for the diagnosis of SCD. Approximately one third of the SCD patients have normal or elevated serum vitamin B12 level. No differences were found in clinical severity between patients with normal or elevated serum vitamin B12 level and those with low level of serum vitamin B12 on admission.
The efficacy and safety of cooled-radiofrequency neurotomy in the treatment of chronic thoracic facet (zygapophyseal) joint pain
Authors: Gungor Semih , Candan Burcu
Published: April 2020

Anatomic course of medial branches in the thoracic spine is significantly different. Cooled RFA (CRFA) is a newer technique that can create a larger spherical lesion with a potential to compensate for the anatomic variability of the medial branches in the thoracic spine. Our retrospective study aimed to investigate the efficacy and the adverse effects of the CRFA in the treatment of thoracic facet-related pain.

For this retrospective study, we evaluated 40 CRFA performed on 23 patients. The patients with diagnosis of thoracic facet joint-related pain underwent CRFA. Pain scores in numeric rating scale (NRS) were recorded at pretreatment and posttreatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥ 50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.

Improvement of average pain level was 20.72% in the 1st follow-up (FU) (4–8 weeks), 53% in the 2nd FU (2–6 months), and 37.58% in the 3rd FU (6–12 months). Subgroup analysis was done based on age cutoff (age in years ≤ 50 versus >50), and pretreatment NRS (≤7 versus >7). Patients with age ≤50 and NRS score >7 experienced the best pain relief in the 2nd FU period (2–6 months). The patients with age > 50 and NRS pain level ≤7 showed steadily increased benefit both in the 2nd FU (2–6 months) and 3rd FU (6–12 months).

This is the first clinical study to evaluate the efficacy and adverse effects of CRFA in the thoracic spine for facet joint-related pain. Our results suggest that CRFA procedure is an effective treatment modality for thoracic facet-related pain. Our subgroup analysis demonstrated that the pain relief and duration varies with the age and the pretreatment pain levels.
A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature
Authors: Chen Haiying , Li Yuxiang , Zhang Peng , Wang Yang
Published: April 2020

Rationale:

Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in the acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after the recovery stage. The relationship between Hantaan virus infection and empty Sella syndrome (ESS) has rarely been reported.

Patient concerns:

This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache, and backache with dizziness and oliguria. Physical examination was notable for hypotension and the signs of conjunctival suffusion. His platelets decreased, and his urine protein was positive. Hantaan virus IgM and virus RNA were positive.

Diagnosis:

He was diagnosed as having HFRS. In his diuretic phase, his 24-hour urine volume was maintained at 10,000 mL, and his blood pressure was higher for a week. Then, he was diagnosed as having ESS after a series of examinations.

Interventions:

Hormone replacement therapy was given to this patient after the diagnosis “ESS” was made.

Outcomes:

The patient's symptoms improved, and he was discharged from the hospital soon after hormone replacement therapy.

Lessons:

Pituitary function examination and brain magnetic resonance imaging (MRI) need to be considered to scan for ESS and panhypopituitarism in the patients with HFRS accompanied by diabetes insipidus.