bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant risk of pelvic mass after hysterectomy for adenomyosis or endometriosis
Authors: Chao Xiaopei , Liu Yang , Ji Mingliang , Wang Shu , Shi Honghui , Fan Qingbo , Lang Jinghe
Published: April 2020

Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance.

This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis.

This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital.

A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis.

The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.
Randomized control trial of ultrasound-guided erector spinae block versus shoulder periarticular anesthetic infiltration for pain control after arthroscopic shoulder surgery
Authors: Czuczman Mark , Shanthanna Harsha , Alolabi Bashar , Moisiuk Peter , O’Hare Turlough , Khan Moin , Forero Mauricio , Davis Kimberly , Moro Jaydeep , Vanniyasingam Thuva , Thabane Lehana
Published: April 2020

Introduction:

Moderate to severe postoperative pain and associated opioid use may interfere with patients’ well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain.

Methods:

This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat.

Discussion:

This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block.

Trial registration number:

NCT03691922; Recruited Date of registration: October 2, 2018.
Risk factors of perioperative blood transfusion in elderly patients with femoral intertrochanteric fracture
Authors: Dai Cheng-Qian , Wang Li-Hong , Zhu Ye-Qin , Xu Guo-Hong , Shan Jun-Biao , Huang Wei-Chun , Wei Li-Hong , Zhou Fang-Lun , Li Yong
Published: April 2020

This study aimed to discuss the risk factors of perioperative blood transfusion after the application of proximal femoral nail antirotation (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture (FIF). Moreover, this study also aimed to analyze the causes of perioperative blood transfusion and provide guidance for clinical treatment.

Records of elderly patients with FIF who were treated with PFNA in our hospital from September 2014 to May 2017 were reviewed. They were divided into transfused and nontransfused groups. The Student t test, Chi-squared test, and Fisher exact test were used in univariate analysis of 11 variables. Multivariate logistic regression analysis was performed to analyze the possible risk factors associated with postoperative blood transfusion after the application of PFNA in elderly patients with FIF. Correlations were sought using the Spearman rank correlation analysis.

The univariate analysis showed that age, sex, type of fracture, admission hemoglobin (Hb), admission albumin, and intraoperative blood loss were significantly associated with perioperative blood transfusion (P = .000, .019, .000, .000, .000, and .007, respectively). The multivariate logistic regression analysis demonstrated that age (P = .019, odds ratio [OR] = 1.062), type of fracture (P = .001, OR = 4.486), and admission Hb (P = .000, OR = 0.883) were independent risk factors of postoperative blood transfusion. We found a significant positive correlation between perioperative blood transfusion and age (r = 0.264, P = .000) and type of fracture (r = 0.409, P = .000), but a negative correlation between perioperative blood transfusion and admission Hb (r = −0.641, P = .000).

The main factors affecting perioperative blood transfusion are age, fracture type, and admission Hb. These results indicate that, in high-risk patients who are older in age, more unstable fractures, and lower admission Hb, monitoring Hb concentrations during the perioperative period is important to correct severe anemia in a timely manner and avoid exacerbating existing underlying diseases and inducing severe complications.
Myasthenic crisis and late deep vein thrombosis following thymectomy in a patient with myasthenia gravis
Authors: Lin Cheng-Yuan , Liu Wei-Cheng , Chiang Min-Hsien , Tsai I-Ting , Chen Jen-Yin , Cheng Wan-Jung , Ho Chun-Ning , Liao Shu-Wei , Chu Chin-Chen , Sun Cheuk-Kwan , Hung Kuo-Chuan
Published: April 2020

Introduction:

Surgical stress and pain are potential provoking factors for postoperative myasthenic crisis (POMC). We report the occurrence of early POMC and late deep vein thrombosis (DVT) in a man with myasthenia gravis (MG) undergoing thymectomy, addressing possible link between reversal of opioid overdose with naloxone and the triggering of POMC.

Patient concerns:

A 71-year-old man with impaired renal function (ie, estimated glomerular filtration rate [egfr]: 49.1 mL/min/1.73 m2) with diagnosis of MG made 2 months ago was scheduled for thymectomy. After uncomplicated surgery, he experienced opioid overdose that was treated with naloxone. Hyperlactatemia then developed with a concomitant episode of hypertension. Three hours after reversal, he suffered from myasthenic crisis presenting with respiratory failure and difficult weaning from mechanical ventilation.

Diagnosis:

Stress-induced hyperlactatemia and subsequent myasthenic crisis

Interventions:

Pyridostigmine and immunosuppressive therapy with prednisolone were initiated. Hyperlactatemia subsided on postoperative day (POD) 5. Tracheal extubation was performed successfully on POD 6.

Outcomes:

During the course of hospitalization, his eGFR (ie, 88.9 mL/min/1.73 m2) was found to improve postoperatively. After discharge from hospital, he developed DVT in the left femoral and popliteal veins on POD 24 when he was readmitted for immediate treatment with low-molecular-weight heparin. He was discharged without sequelae on POD 31. There was no recurrence of myasthenic crisis or DVT at 3-month follow-up.

Conclusions:

Following naloxone administration, hyperlactatemia may be an indicator of pain-related stress response, which is a potential provoking factor for myasthenic crisis. Additionally, patients with MG may have an increased risk of DVT possibly attributable to immune-mediated inflammation. These findings highlight the importance of perioperative avoidance of provoking factors including monitoring of stress-induced elevations in serum lactate concentration, close postoperative surveying for myasthenic crisis, and early recognition of possible thromboembolic complications in this patient population.
Bioinformatic identification of hub genes and key pathways in neutrophils of patients with acute respiratory distress syndrome
Authors: Hu Lan , Zhao Tianxin , Sun Yuelin , Chen Yingfu , Bai Ke , Xu Feng
Published: April 2020

Acute respiratory distress syndrome (ARDS) is characterized as a neutrophil-dominant disorder without effective pharmacological interventions. Knowledge of neutrophils in ARDS patients at the transcriptome level is still limited. We aimed to identify the hub genes and key pathways in neutrophils of patients with ARDS. The transcriptional profiles of neutrophils from ARDS patients and healthy volunteers were obtained from the GSE76293 dataset. The differentially expressed genes (DEGs) between ARDS and healthy samples were screened using the limma R package. Subsequently, functional and pathway enrichment analyses were performed based on the database for annotation, visualization, and integrated discovery (DAVID). The construction of a protein–protein interaction network was carried out using the search tool for the retrieval of interacting genes (STRING) database and the network was visualized by Cytoscape software. The Cytoscape plugins cytoHubba and MCODE were used to identify hub genes and significant modules. Finally, 136 upregulated genes and 95 downregulated genes were identified. Gene ontology analyses revealed MHC class II plays a major role in functional annotations. SLC11A1, ARG1, CHI3L1, HP, LCN2, and MMP8 were identified as hub genes, and they were all involved in the neutrophil degranulation pathway. The MAPK and neutrophil degranulation pathways in neutrophils were considered as key pathways in the pathogenesis of ARDS. This study improves our understanding of the biological characteristics of neutrophils and the mechanisms underlying ARDS, and key pathways and hub genes identified in this work can serve as targets for novel ARDS treatment strategies.
Methotrexate-associated lymphoproliferative disorders in the central nervous system and stomach
Authors: Kawazoe Mai , Kaneko Kaichi , Nanki Toshihiro
Published: April 2020

Rationale:

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a serious complication in patients treated using methotrexate. It occasionally develops in extra-nodal sites, but rarely in the central nervous system (CNS) or in 2 different sites at the same time. We present the rare case of a patient with rheumatoid arthritis who developed lymphoma in the CNS and stomach during MTX therapy.

Patient concerns:

A 75-year-old Japanese man with rheumatoid arthritis who received methotrexate was admitted to our hospital because of gait ataxia and anorexia.

Diagnoses:

Imaging findings and biopsy led to a diagnosis of 2 different types of MTX-LPD in the central nervous system and stomach.

Interventions:

The lesion in his stomach improved after methotrexate withdrawal, whereas the cerebellar mass required high-dose methotrexate and rituximab therapy.

Outcomes:

Complete remission has been maintained for the 2 years following the initiation of chemotherapy.

Lessons:

In patients with RA who receive MTX and develop new neurological symptoms, CNS lymphoma as an MTX-LPD may be considered as a differential diagnosis.
Liver stiffness across different chronic liver disease under therapy with statin in a real life cohort
Authors: Markova Antoaneta A. , Deterding Katja , Port Kerstin , Bantel Heike , Manns Michael P. , Cornberg Markus , Wedemeyer Heiner
Published: April 2020

Introduction

Statins have been associated with improved clinical outcomes in patients with viral hepatitis and after variceal bleeding. Still, the clinical benefit of statins is not well defined for different liver diseases. Moreover, associations between statin use and liver stiffness as well as event free survival have not been established.

Methods

Liver stiffness was evaluated in 6490 patients with liver disease (January 2012 till December 2016). Two hundred thirty-four of those received statin therapy, 468 controls without statins were selected by a 1:2 case by case matching using age, sex, underlying liver disease and BMI.

Results

Statins were given to 234 patients with chronic virus hepatitis (n = 104), nonalcoholic fatty liver disease (n = 52), autoimmune liver disease including autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis (n = 31) and hepatitis of unknown origin (n = 47). Follow-up data were available for 96 and 119 pairs (mean follow-up 2 years). Statin users showed reduced inflammatory activity. Elevated liver enzymes were reported in 57% of statin-treated compared with 70% of controls (mean alanine aminotransferase level 53 vs. 74 U/l; P < 0.001). Statin use was well tolerated in this cohort. Mean liver stiffness values were 10.7 kPa (SEM 0.7) and 15.5 kPa (SEM 0.7) accordingly (P < 0.0001). Decompensation was less likely to occur in the statin group, both groups do not defer in the incidence of liver tumor occurrence, transplantation or death (odds ratio = 1, P = nonsignificant).

Conclusions

Use of statins was well tolerated irrespective of liver disease. Statin users showed reduced hepatic inflammatory activity, less severe markers of liver stiffness and portal hypertension. There might be a beneficial effect of statin on the risk to experience hepatic decompensation.
Efficacy of Second-Line Chemotherapy in Extrapulmonary Neuroendocrine Carcinoma
Authors: McGarrah Patrick W. , Leventakos Konstantinos , Hobday Timothy J. , Molina Julian R. , Finnes Heidi D. , Westin Gustavo F. , Halfdanarson Thorvardur R.
Published: April 2020

Objectives

A platinum/etoposide doublet is standard first-line therapy for poorly differentiated neuroendocrine carcinoma (PD NEC); however, evidence to guide treatment beyond first-line regimens is lacking. This study aimed to evaluate the efficacy of second-line regimens in PD NEC.

Methods

We performed a retrospective analysis of patients treated with second-line chemotherapy for PD NEC. Inclusion criteria were previous first-line therapy with platinum/etoposide, extrapulmonary PD NEC, and follow-up data. The primary end points were overall survival (OS) and progression-free survival (PFS) after second-line therapy. Secondary end points included OS and PFS from first-line therapy.

Results

Sixty-four patients were included. The median OS from initiation of second-line therapy was 6.2 months (95% confidence interval [CI], 4.9–8.9). The median PFS was 2.3 months (95% CI, 2.0–3.2). No second-line regimen showed a statistically significant difference in OS or PFS. There was a significant increase in OS for cisplatin first-line regimens compared with carboplatin (17.0 months [95% CI, 12.5–22.6] vs 11.7 months [95% CI, 8.0–14.0]).

Conclusions

The efficacy of current second-line therapy in PD NEC is poor. No second-line regimen showed statistically significant superiority. Cisplatin was associated with longer OS regardless of second-line regimen or age. However, unmeasured confounders such as performance status or comorbidities may explain this effect.
miR-375 Inhibits Autophagy and Further Promotes Inflammation and Apoptosis of Acinar Cells by Targeting ATG7
Authors: Zhao Shang-Ping , Yu Can , Xiang Kai-Min , Yang Ming-Shi , Liu Zuo-Liang , Yang Bing-Chang
Published: April 2020

Objectives

MicroRNAs have been considered to be closely related with the development of severe acute pancreatitis (SAP), and microRNA-375 (miR-375) was believed to be a marker of SAP. We aim to investigate the role of miR-375 in regulating SP.

Methods

Cerulein and lipopolysaccharide were used to establish the models of SAP. AR42J cell line was chosen for study in vitro. Flow cytometry was applied for assessing apoptosis. The contents of inflammatory factors were detected with related enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction assays. Hematoxylin and eosin staining was applied to observe the pathological changes of pancreatic tissues. Immunohistochemistry analysis was conducted for investigating the expression of light chain 3.

Results

The level of miR-375 in pancreatitis tissues and cell lines was upregulated. Overexpression of miR-375 promoted inflammation and the apoptosis of acinar cells through inhibiting autophagy. The binding site between miR-375 and ATG7 was identified, and miR-375 could directly regulate the ATG7. microRNA-375 suppressed autophagy and promoted inflammation and the apoptosis of acinar cells via targeting ATG7.

Conclusions

We proved that miR-375 could inhibit autophagy and promote inflammation and the apoptosis of acinar cells through regulating ATG7. This study first proves that miR-375 modulates the development of SAP through targeting ATG7.
Induction of HLA-B27–Associated Reactive Arthritis After a Wharton’s Jelly “Stem Cell” Injection
Authors: Madhoun Hareth , Landry Kristen , Baria Michael R.
Published: April 2020

Orthobiologic injections are an emerging treatment option for musculoskeletal conditions. Allogenic gestational tissue–derived products, including umbilical cord–derived Wharton’s jelly, are among the available options. These tissues are currently being harvested and sold by companies as an off-the-shelf “stem cell” injection for conditions such as back pain and osteoarthritis. Despite documented infections from similar umbilical cord derivatives, “stem cell clinics” continue to use them. Here, we report the first documented case of HLA-B27–associated reactive arthritis induced by a Wharton’s jelly stem cell injection. A 36-yr-old man was injected with Wharton’s jelly for low back pain and within 24 hours developed fevers, chills, polyarthritis, and enthesitis. Infectious disease work-up was negative. Inflammatory markers were elevated and his HLA-B27 antigen was positive. Initial treatment included methylprednisolone and sulfasalazine. This case highlights the unknown dangers of these allogenic injections and physicians should remain cautious about their use until further study and regulation can ensure patient safety.
Early Extended Midline Strip Craniectomy for Sagittal Synostosis
Authors: O’Connell John Edward , Ellenbogen Jonathan , Parks Chris
Published: April 2020

Background:

Isolated sagittal synostosis is the most common form of nonsyndromic craniosynostosis. The surgical management of this condition ranges from strip craniectomy to total cranial vault remodeling. In our unit, passive correction of sagittal synostosis utilizing open extended midline strip craniectomy with bilateral micro-barrel staving is performed before 22 weeks corrected age. The aim of this prospective study is to identify the effectiveness and morbidity associated with this technique.

Patients and Methods:

Nonsyndromic patients who underwent OMEC at a tertiaryreferral-center (Alder Hey Children's Hospital, Liverpool, UK) over a 3-year period (2014–2016) were included. In particular, we looked at pre- and postoperative cranial index (CI), as well as other secondary outcomes such as rates of transfusion and reoperation.

Results:

A total of 44 patients (12 female, 32 male) met the inclusion criteria. Median age at operation was 132 (range 99–171) days. Median operative time was 117 (range 89–171) minutes. Twenty-four patients underwent a blood transfusion. Median pre-op CI was 66 (range 61–74.7)%. The first post-op CI, taken a median of 56 (range 12–107) days postoperatively, was 78 (range 73–87)%. No patients required reoperation. There were no perioperative deaths.

Conclusion:

Early open extended midline strip craniectomy with bilateral micro-barrel staving for correction of isolated nonsyndromic sagittal synostosis is a safe and effective technique, associated with minimal morbidity, producing sustained satisfactory head shape morphology on short to medium-term follow-up.
Delayed Periorbital Reconstruction After War Injuries
Authors: Abu-Sitta Ghassan S. , Ma’luf Riad , Dabbous Helene , Hakim Christopher , Chalhoub Rawad
Published: April 2020

Introduction:

Syrian patients injured in the war frequently undergo rudimentary primary wound closure in combat zones. These patients are later transferred to Lebanon where their wounds need to be secondarily managed. This often leads to the creation of unorthodox approaches for reconstruction of orbital injuries.

Case presentation:

The authors of this manuscript demonstrate a few cases of peri-ocular trauma with a delayed presentation, in which adaptations of conventional reconstructive methods had to be implemented had to be undertaken for optimal results.

Conclusion:

Modified techniques for reconstruction of peri-ocular injuries with delayed presentation are discussed in this paper. The patients are cases of trauma secondary to war in the region of Lebanon and Syria. The unique presentations of these patients have led to the use of “opportunity flaps” surrounding highly fibrotic and scarred tissue, in an attempt to allow for delayed reconstruction.
Timing of Ossification of the Anterior Skull Base in Syndromic Synostosis
Authors: Nassar Amer H. , Mercan Ezgi , Massenburg Benjamin B. , Lee Amy , Brown Jevon , Skladman Rachel , Guo Yifan , Hopper Richard A.
Published: April 2020

The anterior skull base undergoes a progressive ossification after birth. This has implications on the epidural dissection of early trans-craniofacial osteotomy procedures such as monobloc advancements. Our purpose was to determine the rate of ossification in syndromic synostosis patients relative to a normal cohort to establish when maturation of the anterior skull base is complete. The authors analyzed CT scans from 35 patients with Crouzon, Apert or Pfeiffer syndrome, and 84 patients without any craniofacial anomaly between the ages of 0 and 6 years. The non-ossified anterior skull base area was measured using 3D Slicer. The authors compared the sizes of the defects at different ages between the three syndromes and with the control group using Mann-Whitney test. Significance was set at P < 0.05. All patients less than 12 months of age had a measurable defect anterior to the cribriform whereas patients greater than five years of age had full ossification of the anterior skull base with no evidence of defect. The relationship of defect size and age at scan was non-linear, with most defects closing rapidly in the first six months. The temporal closure pattern of the defect was similar between the three syndromes and the control group with no significant difference. Our findings indicate that syndromic children undergo skull base maturation at the same rate as non-syndromic cases, with the majority ossified by three years of age. Anterior skull base surgeries performed before three years should optimize visualization of this area during dissection.
The Use of A Solitary Multi-Planer Herbert Cannulated Bone Screw Osteosynthesis for The Treatment of Mandibular Angle Fracture
Authors: El-Mahallawy Yehia , Al-Mahalawy Haytham
Published: April 2020

This study aimed to evaluate the clinical and radiographic performance of a single Herbert bone screw in the treatment of mandibular angle fractures. A prospective case series clinical trial enrolling a sample of patients with unilateral isolated mandibular angle fractures was implemented in this study. The primary outcome variable was the fracture healing with postoperative stability. The secondary outcome was the incidence of postoperative complications. All of the recorded data were documented, tabulated, computed, and analyzed. Statistical significance was set at 5% level. Twenty patients were selected. Neither major nor minor clinical complication was reported. Only one case showed slight interfragmentary mobility in the first follow-up period, which improved spontaneously in the sixth postoperative week. A statistically significant gain in the mean bone density across the fracture line was calculated. These favorable clinical and radiographic outcomes may conclude that the utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures.
Orbital Trapdoor Facture in Child: More Predictable Outcomes and Less Consequences
Authors: Guerra Raphael Capelli , Pulino Bianca F. Borim , Mendes Bruno Coelho , Pereira Rodrigo dos Santos , Pinheiro Flávia Lima , Hochuli-Vieira Eduardo
Published: April 2020

Orbital trapdoor fractures are characterized by tissue entrapment between the fractured bone fragment and the remnant of the orbital floor. This entrapment can result in immediate local and systemic complications and poor outcomes when approached late. This article presents the case of an orbital floor fracture in a child with dystopia, pain, edema and entrapment of the inferior rectus muscle and consequent limitation of ocular motility. The strategy proposed in the early approach to orbital floor reconstruction and release of incarcerated tissue allowed the patient to achieve satisfactory results without morbidity, as compared to the outcomes of corrective sequel surgery.
Prophylactic Topical Tranexamic Acid Versus Placebo in Surgical Patients
Authors: Teoh Wan Yi , Tan Tun Giap , Ng Ka Ting , Ong Ke Xin , Chan Xue Lin , Hung Tsan Samuel Ern , Wang Chew Yin
Published: April 2020

Objectives:

Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the literature. The primary aim of this review was to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery.

Data sources:

EMBASE, MEDLINE, CENTRAL, and ISI Web of Science were systematically searched from their inception until May 31, 2019.

Review methods:

Parallel-arm randomized controlled trials were included.

Results:

Seventy-one trials (7539 participants: orthopedics 5450 vs nonorthopedics 1909) were included for quantitative meta-analysis. In comparison to placebo, topical TXA significantly reduced intraoperative blood loss [mean difference (MD) −36.83 mL, 95% confidence interval (CI) −54.77 to −18.88, P < 0.001], total blood loss (MD −319.55 mL, 95% CI −387.42 to −251.69, P < 0.001), and incidence of blood transfusion [odds ratio (OR) 0.30, 95% CI 0.26–0.34, P < 0.001]. Patients who received topical TXA were associated with a shorter length of hospital stay (MD −0.28 days, 95% CI −0.47 to −0.08, P = 0.006). No adverse events associated with the use of topical TXA were observed, namely mortality (OR 0.78, 95% CI 0.45–1.36, P = 0.39), pulmonary embolism (OR 0.73, 95% CI 0.27–1.93, P = 0.52), deep vein thrombosis (OR 1.07, 95% CI 0.65–1.77, P = 0.79), myocardial infarction (OR 0.79, 95% CI 0.21–2.99, P = 0.73), and stroke (OR 0.85, 95% CI 0.28–2.57, P = 0.77). Of all included studies, the risk of bias assessment was “low” for 20 studies, “unclear” for 26 studies and “high” for 25 studies.

Conclusions:

In the meta-analysis of 71 trials (7539 patients), topical TXA reduced the incidence of blood transfusion without any notable adverse events associated with TXA in adults undergoing surgery.

PROSPERO:

CRD 42018111762.
Optic Nerve Regeneration: How Will We Get There?
Authors: Gokoffski Kimberly K. , Lam Phillip , Alas Basheer F. , Peng Micalla G. , Ansorge Heidi R. R.
Published: April 2020

Background:

Restoration of vision in patients blinded by advanced optic neuropathies requires technologies that can either 1) salvage damaged and prevent further degeneration of retinal ganglion cells (RGCs), or 2) replace lost RGCs.

Evidence Acquisition:

Review of scientific literature.

Results:

In this article, we discuss the different barriers to cell-replacement based strategies for optic nerve regeneration and provide an update regarding what progress that has been made to overcome them. We also provide an update on current stem cell-based therapies for optic nerve regeneration.

Conclusions:

As neuro-regenerative and cell-transplantation based strategies for optic nerve regeneration continue to be refined, researchers and clinicians will need to work together to determine who will be a good candidate for such therapies.
Impact of early use of long-acting injectable antipsychotics on psychotic relapses and hospitalizations in first-episode psychosis
Authors: Abdel-Baki Amal , Medrano Sofia , Maranda Catherine , Ladouceur Martin , Tahir Ramzan , Stip Emmanuel , Potvin Stéphane
Published: April 2020

Early relapse is frequent in the first-episode psychosis (FEP), often because of poor adherence to medication. Previous studies have shown positive impacts of long-acting injectable antipsychotics (LAI-AP) on relapse rates, while others have discerned no differences. This study describes the impact of early LAI-AP utilization on relapse and rehospitalization rates in FEP. A three-year, longitudinal, prospective, naturalistic study of all admissions of psychosis patients for early intervention services was conducted. Four hundred sixteen patients were subdivided into four groups according to the route of antipsychotic administration. Patients who received LAI-AP as their first treatment modality were more likely to exhibit poor prognostic factors at baseline. However, their relapse rate over time was similar to those with good prognostic factors at baseline who only received oral antipsychotics (OAP). Patients who were initially prescribed OAP and eventually switched to LAI-AP were more likely to relapse and to be rehospitalized, even if they manifested better functioning at baseline than those started on LAI-AP. Patients with poor prognosis in the early stage of their disease seem to benefit from early prescription of LAI-AP which can reduce and delay relapses and rehospitalizations. Because they are often still at school or at work at the time of their first episode of psychosis, relapse prevention seems particularly relevant to avoid functional deterioration.
Vitamin D recommendations in nutritional guidelines: Protocol for a systematic review, quality evaluation using AGREE-2 and analysis of potential predictors
Authors: Fraile-Navarro D , López-García-Franco A , Niño de Guzmán E , Pardo-Hernandez H , Canelo-Aybar C , Kuindersma J , Gich-Saladich I , Alonso-Coello P.
Published: April 2020

Background

Vitamin D has been widely promoted for bone health through supplementation and fortification of the general population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and explore predictive factors for their direction and strength.

Methods and analysis

We searched PubMed, EMBASE and CINAHL databases for vitamin D guidelines for the last 10 years. We aim to perform descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association recommendations and AGREE II domains’ scores and pre-specified characteristics.

Ethics and dissemination

This is a systematic review protocol and therefore formal ethical approval is not required, as no primary, identifiable, personal data will be collected. Patients or the public were not involved in the design of our research. However, the findings from this review will be shared with key stakeholders, including patient groups, clinicians and guideline developers. We intend to publish our results in a suitable, peer-reviewed journal.
The aging transcriptome and cellular landscape of the human lung in relation to SARS-CoV-2
Authors: Chow Ryan D. , Chen Sidi
Published: April 2020

Since the emergence of SARS-CoV-2 in December 2019, Coronavirus Disease-2019 (COVID-19) has rapidly spread across the globe. Epidemiologic studies have demonstrated that age is one of the strongest risk factors influencing the morbidity and mortality of COVID-19. Here, we interrogate the transcriptional features and cellular landscapes of the aging human lung through integrative analysis of bulk and single-cell transcriptomics. By intersecting these age-associated changes with experimental data on host interactions between SARS-CoV-2 or its relative SARS-CoV, we identify several age-associated factors that may contribute to the heightened severity of COVID-19 in older populations. We observed that age-associated gene expression and cell populations are significantly linked to the heightened severity of COVID-19 in older populations. The aging lung is characterized by increased vascular smooth muscle contraction, reduced mitochondrial activity, and decreased lipid metabolism. Lung epithelial cells, macrophages, and Th1 cells decrease in abundance with age, whereas fibroblasts, pericytes and CD4+ Tcm cells increase in abundance with age. Several age-associated genes have functional effects on SARS-CoV replication, and directly interact with the SARS-CoV-2 proteome. Interestingly, age-associated genes are heavily enriched among those induced or suppressed by SARS-CoV-2 infection. These analyses illuminate potential avenues for further studies on the relationship between the aging lung and COVID-19 pathogenesis, which may inform strategies to more effectively treat this disease.
Rapid Point-Of-Care Breath Test Predicts Breast Cancer And Abnormal Mammograms in Symptomatic Women
Authors: Phillips Michael , Bevers Therese B , Larsen Linda Hovanessian , Pappas Nadine , Pathak Sonali
Published: April 2020

Background

Previous studies have reported volatile organic compounds (VOCs) in the breath as biomarkers of breast cancer. These biomarkers may be derived from cancer-associated fibroblasts, in which oxidative stress degrades polyunsaturated fatty acids to volatile alkanes and methylated alkane derivatives that are excreted in the breath. We evaluated a rapid point-of-care test for breath VOC biomarkers as predictors of breast cancer and abnormal mammograms.

Methods

We studied 593 women aged ≥ 18 yr referred to three sites for mammography for a symptomatic breast-related concern (e.g. breast mass, nipple discharge). A rapid point-of-care breath testing system collected and concentrated alveolar breath VOCs on a sorbent trap and analyzed them with gas chromatography and surface acoustic wave detection in < 6 min. Breath VOC chromatograms were randomly assigned to a training set or to a validation set. Monte Carlo analysis identified significant breath VOC biomarkers of breast cancer and abnormal mammograms in the training set, and these biomarkers were incorporated into a multivariate algorithm to predict disease in the validation set.

Results

Prediction of breast cancer: 50 women had biopsy-proven breast cancer (invasive cancer 41, ductal non-invasive cancer 9) Unsplit data set: Breath VOCs identified breast cancer with 83% accuracy (area under curve of receiver operating characteristic), 82% sensitivity and 77.1% specificity. Split data sets: Training set breath VOCs identified breast cancer with 80.3% accuracy, 84% sensitivity and 74.3% specificity. Corresponding values in the validation set were 68%% accuracy, 72.4% sensitivity and 61.5% specificity.

Prediction of BIRADS 4 and 5 mammograms (versus BIRADS 1, 2 and 3): Unsplit data set: Breath VOCs identified abnormal mammograms with 76.2% accuracy. Split data sets: Breath VOCs identified abnormal mammograms with 74.2% accuracy, 73.3% sensitivity and 60% specificity. Corresponding values in the validation set were 60.5% accuracy, 64.2% sensitivity and 51% specificity.

Conclusions

A rapid point-of-care test for breath VOC biomarkers accurately predicted risk of breast cancer and abnormal mammograms in women with breast-related symptoms.
Textile Masks and Surface Covers – A ‘Universal Droplet Reduction Model’ Against Respiratory Pandemics
Authors: Rodriguez-Palacios Alex , Cominelli Fabio , Basson Abigail R. , Pizarro Theresa T. , Ilic Sanja
Published: April 2020

The main form of COVID-19 transmission is via ‘oral-respiratory droplet contamination’ (droplet; very small drop of liquid) produced when individuals talk, sneeze or cough. In hospitals, health-care workers wear facemasks as a minimum medical ‘droplet precaution’ to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, given that asymptomatic individuals, not wearing masks within the public, can be highly contagious for COVID-19, prevention of ‘environmental droplet contamination’ (EnDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote ‘public droplet safety’, we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal ‘community droplet reduction solution’ is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8m, the minimum distance recommended for COVID-19 ‘social distancing’. All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10cm, and the area of circumferential contamination to ∼0.3%. The synchronized implementation of EDBs as a ‘community droplet reduction solution’ (i.e., face covers/scarfs/masks & surface covers) could reduce EnDC and the risk of transmitting or acquiring infectious respiratory pathogens, including COVID-19.
Variation in False Negative Rate of RT-PCR Based SARS-CoV-2 Tests by Time Since Exposure
Authors: Kucirka Lauren M , Lauer Stephen A , Laeyendecker Oliver , Boon Denali , Lessler Justin
Published: April 2020

SARS-CoV-2 RT-PCR based tests are being used to “rule out” infection among high-risk individuals such as exposed inpatients and healthcare workers. It is critical to understand how the predictive value of the test varies with time from exposure and symptom onset in order to avoid being falsely reassured by negative tests. As such, the goal of our study was to estimate the false negative rate by day since infection. We used previously published data on RT-PCR sensitivity on samples derived from nasal swabs by day since symptom onset (n=633) and fit a cubic polynomial spline to calculate the false negative rate by day since exposure and symptom onset. Over the four days of infection prior to the typical time of symptom onset (day 5) the probability of a false negative test in an infected individual falls from 100% on day one (95% CI 69-100%) to 61% on day four (95% CI 18-98%), though there is considerable uncertainty in these numbers. On the day of symptom onset, the median false negative rate was 39% (95% CI 16-77%). This decreased to 26% (95% CI 18-34%) on day 8 (3 days after symptom onset), then began to rise again, from 27% (95% CI 20-34%) on day 9 to 61% (95% CI 54-67%) on day 21. Care must be taken when interpreting RT-PCR tests for SARS-CoV-2 infection, particularly if performed early in the course of infection, when using these results as a basis for removing precautions intended to prevent onward transmission. If there is high clinical suspicion, patients should not be ruled out on the basis of RT-PCR alone, and the clinical and epidemiologic situation should be carefully considered.
Spatial Correlation of Particulate Matter Pollution and Death Rate of COVID-19
Authors: Yao Ye , Pan Jinhua , Wang Weidong , Liu Zhixi , Kan Haidong , Meng Xia , Wang Weibing
Published: April 2020

The Coronavirus (COVID-19) epidemic, which was first reported in December 2019 in Wuhan, China, has caused 3,314 death as of March 31, 2020 in China. This study aimed to investigate the spatial associations of daily particulate matter (PM) concentrations with death rate of COVID-19 in China. We conducted a cross-sectional analysis to examine the spatial associations of daily PM2.5 and PM10 concentrations with death rate of COVID-19 in China through multiple linear regression method. We found that COVID-19 held higher death rates with increasing concentration of PM2.5 and PM10 levels in the spatial scale, which may affect the process of patients developed from mild to severe and finally influence the prognosis of COVID-19 patients.
COVID-19 UK Lockdown Forecasts and R0
Authors: Dropkin Greg
Published: April 2020

Introduction

The first reported UK case of COVID-19 occurred on 31 January 2020, and a lockdown of unknown duration began on 24 March. One model to forecast disease spread depends on clinical parameters and transmission rates. Output includes the basic reproduction number R0 and the log growth rate r in the exponential phase.

Methods

UK data on reported deaths is used to estimate r. A likelihood for the transmission parameters is defined from a gaussian density for r using the mean and standard error of the estimate. Parameter samples from the Metropolis-Hastings algorithm lead to an estimate and credible interval for R0 and forecasts for severe and critical cases, and deaths during a lockdown.

Results

In the exponential phase, the UK growth rate for log(deaths) is r = 0.224 with s.e. 0.005. R0 = 5.81 with 90% CI (5.08, 6.98). In a 12 week lockdown from 24 March with transmission parameters reduced to 20% of their previous values, around 63,000 severely ill patients will need hospitalisation by mid June, 37,000 critically ill will need intensive care, whilst over 81,000 are expected to die. Had the lockdown begun on 17 March around 16,500 severe, 9,250 critical cases and 18,500 deaths would be expected by early June. With 10% transmission, severe and critical cases peak in April.

Discussion

The R0 estimate is around twice the value quoted by the UK government. The NHS faces extreme pressures, even if transmission is reduced ten-fold. An earlier lockdown could have saved many lives.
Routine deworming during antenatal care decreases risk of neonatal mortality and low birthweight: a retrospective cohort of survey data
Authors: Walia Bhavneet , Kmush Brittany L. , Lane Sandra D. , Endy Timothy , Montresor Antonio , Larsen David A.
Published: April 2020

Background

Soil transmitted helminths (STH) are a common infection among pregnant women in areas with poor access to sanitation. Deworming medications are cheap and safe; however, the health benefit of deworming during pregnancy is not clear.

Methods / Principal Findings

We created a retrospective cohort of more than 800,000 births from 95 Demographic and Health Survey datasets to estimate the impact of deworming medicine during routine antenatal care (ANC) on neonatal mortality and low birthweight. We first matched births on the probability of receiving deworming during ANC. We then modeled the birth outcomes with the matched group as a random intercept to estimate the effect of deworming during antenatal care after accounting for various risk factors. We also tested for effect modification of soil transmitted helminth prevalence on the impact of deworming during ANC. Receipt of deworming medication during ANC was associated with a 15% reduction in the risk of neonatal mortality (95% confidence interval = 11-18%, n = 797,772 births), with no difference between high and low transmission countries. In low transmission countries, we found an 11% reduction in the odds of low birth weight (95% confidence interval = 8-13%) for women receiving deworming medicine and in high transmission we found a 3% reduction in the odds of low birthweight (95% confidence interval = 1-5%).

Conclusions / Significance

These results suggest a substantial health benefit for deworming during ANC that may be even greater in countries with low STH transmission.
Air Pollution Increases Influenza Hospitalizations
Authors: Singer Gregor , Zivin Joshua Graff , Neidell Matthew , Sanders Nicholas
Published: April 2020

Seasonal influenza is a recurring health burden shared widely across the globe. We study whether air quality affects the occurrence of severe influenza cases that require inpatient hospitalization. Using longitudinal information on local air quality and hospital admissions across the United States, we find that poor air quality increases the incidence of significant influenza hospital admissions. Effects diminish in years with greater influenza vaccine effectiveness. Apart from increasing vaccination rates, improving air quality may help reduce the spread and severity of influenza.
Measuring integration and influence among health professionals. A social network approach
Authors: Aguirre Nelson , Carswell Peter , Keneally Tim
Published: April 2020

Programs to manage long term conditions in developed countries seek greater integration and communication between health professionals to improve health outcomes. But more empirical evidence is needed to measure integration and influence for health those who are involved in these programs. This paper analyses the way in which health professionals interact at the primary and secondary care interface, based on integrated care design in a program of chronic care in New Zealand. The frequency, quality and perceived value of the interactions between general practitioners, practices nurses, medical specialists and specialist nurses are used as explanatory variables in graphical models which take a social network analysis approach. The paper shows the configuration of the network between health professionals in an integrated care context and explains the academic and policy implication of the findings.
Understanding the B and T cells epitopes of spike protein of severe respiratory syndrome coronavirus-2: A computational way to predict the immunogens
Authors: Vashi Yoya , Jagrit Vipin , Kumar Sachin
Published: April 2020

The 2019 novel severe respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak has caused a large number of deaths with thousands of confirmed cases worldwide. The present study followed computational approaches to identify B- and T-cell epitopes for spike glycoprotein of SARS-CoV-2 by its interactions with the human leukocyte antigen alleles. We identified twenty-four peptide stretches on the SARS-CoV-2 spike protein that are well conserved among the reported strains. The S protein structure further validated the presence of predicted peptides on the surface. Out of which twenty are surface exposed and predicted to have reasonable epitope binding efficiency. The work could be useful for understanding the immunodominant regions in the surface protein of SARS-CoV-2 and could potentially help in designing some peptide-based diagnostics.