bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis
Authors: Ding Weizhong , Chen Shirong , Shi Xuexiang , Zhao Yang
Published: May 2021

Background:

Ankylosing spondylitis is a recurrent autoimmune disease, which has a high disability rate and seriously affects patients’ daily life. Conventional treatment cannot effectively solve the clinical problems of patients, and long-term medication is accompanied by adverse reactions. The evidence shows that warming needle moxibustion has advantages in the treatment of ankylosing spondylitis, but there is still a lack of clinical studies on warm acupuncture alone and long-term follow-up.

Methods:

This is a prospective randomized controlled trial to study the efficacy and safety of needle warming through moxibustion in the treatment of ankylosing spondylitis. It was approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly assigned to an observation group or a control group. The patients were followed up for 6 months after 30 days of treatment. Observation indicators include; activity index, functional ability, Bath Ankylosing Spondylitis Metrology Index, inflammatory indicators, adverse reactions, and so on. Finally, SPASS 22.0 software is used for statistical analysis of the data.

Discussion:

This study will evaluate the clinical efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis. The results of this study will provide a reference basis for the clinical use of warm needle moxibustion in the treatment of ankylosing spondylitis.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/GWPX3
Does tranexamic acid reduce risk of mortality on patients with hemoptysis?
Authors: Chen Liang-Fu , Wang Ting-Cheng , Lin Ting-Yi , Pao Po-Jia , Chu Karen Chia-Wen , Yang Chih-Hao , Chang Jer-Hwa , Hsu Chin-Wang , Bai Chyi-Huey , Hsu Yuan-Pin
Published: May 2021

Background:

Although tranexamic acid (TXA), a readily accessible antifibrinolytic agent, is widely adopted in hemorrhage scenarios, its role on mortality in patients with hemoptysis remains uncertain. New evidence is yet to be generated to evaluate the risk of mortality after using TXA in patients with hemoptysis.

Methods:

PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were searched from inception to May 2020. Randomized controlled trials and observational studies that evaluated the effect of TXA on patients with hemoptysis were included. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.

Main results:

Five studies with a total of 20,047 patients were analyzed. When compared with the control, administration of TXA was associated with a reduction in short-term mortality (risk ratio = 0.78, 95% confidence interval [CI] 0.72–0.85; I
2 = 0), shorter bleeding time (mean difference = − 24.61 hours, 95% CI − 35.96 to −13.26, I
2 = 0), shorter length of hospital stay (mean difference = −1.94 days, 95% CI −2.48 to −1.40, I
2 = 0), and lower need for intervention (risk ratio = 0.38, 95% CI 0.16–0.87, I
2 = 0) in patients with hemoptysis. Compared with control, administration of TXA did not cause increased major or minor adverse effects.

Conclusions:

TXA provided benefits in terms of a lower short-term mortality rate, less bleeding time, shorter length of hospital stays, and less need for intervention in patients with hemoptysis. Use of TXA was not associated with increased adverse effects.
Delta neutrophil index and symptomatic time are effective factors for predicting perforated appendicitis
Authors: Kim Min Jeong , Choi Won Hyuk , Cheong Jin Cheol , Choi Su Yun , Kim Jong Wan , Park Jun Ho
Published: May 2021

Appendicitis is a common intra-abdominal inflammatory disease, and morbidity increases with age when perforation occurs. Because, not all patients require emergency surgery, there have been numerous studies on factors for predicting perforated appendicitis. In this study, we aimed to confirm whether the delta neutrophil index (DNI) and the time from symptom onset to surgery are effective predictors for perforated appendicitis in different age groups.

This was a retrospective study conducted on 542 appendicitis patients who underwent surgery at Kangdong Sacred Heart Hospital. The simple group consisted of 431 subjects, and the perforation group consisted of 111 subjects.

Multiple logistic regression analyses demonstrated that age, neutrophil percentage, DNI, C-reactive protein (CRP), and symptomatic time were significant predictors of perforation. Analysis of the receiver-operating characteristic curve showed that the DNI was the most reliable predictive value. In the analyses according to age, the perforation rate was higher in the >65-year-age group; these patients also had a higher DNI, CRP, and symptomatic time. In the DNI analysis using receiver operating characteristic (ROC) analysis, the area under the curve was higher in the >65-year-age group than in other age groups. In addition, the cutoff values have been determined and perforation occurred significantly in the group with a DNI value of 2.1 or higher and a symptomatic time of 33 hours or longer.

DNI is effective in predicting perforation in patients with appendicitis compared with other inflammatory factors. Furthermore, the simultaneous measurement of symptomatic time and DNI is helpful in predicting perforation and determining whether emergency surgery is necessary.
Exploring biomarkers associated with deteriorating vascular health using a targeted proteomics chip
Authors: Dieden Anna , Malan Leone , Mels Catharina M.C. , Lammertyn Leandi , Wentzel Annemarie , Nilsson Peter M. , Gudmundsson Petri , Jujic Amra , Magnusson Martin
Published: May 2021

In this observational study, by the use of a multiplex proteomic platform, we aimed to explore associations between 92 targeted proteins involved in cardiovascular disease and/or inflammation, and phenotypes of deteriorating vascular health, with regards to ethnicity.

Proteomic profiling (92 proteins) was carried out in 362 participants from the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study of black and white African school teachers (mean age 44.7 ± 9.9 years, 51.9% women, 44.5% Black Africans, 9.9% with known cardiovascular disease). Three proteins with <15% of samples below detectable limits were excluded from analyses. Associations between multiple proteins and prevalence of hypertension as well as vascular health [Carotid intima-media thickness (cIMT) and pulse wave velocity (PWV)] measures were explored using Bonferroni-corrected regression models.

Bonferroni-corrected significant associations between 89 proteins and vascular health markers were further adjusted for clinically relevant co-variates. Hypertension was associated with growth differentiation factor 15 (GDF-15) and C-X-C motif chemokine 16 (CXCL16). cIMT was associated with carboxypeptidase A1 (CPA1), C-C motif chemokine 15 (CCL15), chitinase-3-like protein 1 (CHI3L1), scavenger receptor cysteine-rich type 1 protein M130 (CD163) and osteoprotegerin, whereas PWV was associated with GDF15, E-selectin, CPA1, fatty acid-binding protein 4 (FABP4), CXCL16, carboxypeptidase B (CPB1), and tissue-type plasminogen activator. Upon entering ethnicity into the models, the associations between PWV and CPA1, CPB1, GDF-15, FABP4, CXCL16, and between cIMT and CCL-15, remained significant.

Using a multiplex proteomic approach, we linked phenotypes of vascular health with several proteins. Novel associations were found between hypertension, PWV or cIMT and proteins linked to inflammatory response, chemotaxis, coagulation or proteolysis. Further, we could reveal whether the associations were ethnicity-dependent or not.
A survey on Koreans’ preferred type of collaboration between conventional medical and traditional Korean medicine doctors
Authors: Lee Yoon Jae , Gang Byeong-Gu , Kum Chang Jun , Lee Keunjae , Yoon Young Suk , Lee Jinho , Shin Joon-Shik , Ha In-Hyuk
Published: May 2021

Although collaborative treatment by traditional Korean medicine doctors (KMDs) and medical doctors occurs, it is mainly done by referral. As no survey of the general public's preference for the type of collaboration has ever been conducted, we aimed to investigate Koreans’ preferences for a collaborative treatment type.

The responders were extracted by random digit dialing and then reextracted using the proportional quota sampling method by sex and age. From July to October 2017, telephone interviews were conducted and the participant responses regarding treatment history for spinal or joint diseases, experiences with collaborative treatment, and preferred type of collaborative treatment were recorded.

Of the 1008 respondents, 44.64% reported a history of treatment for spinal or joint diseases at a medical institution. The concurrent collaborative treatment system, in which both KMDs and medical doctors are present in one location participating in the treatment concurrently, was the most preferred system among the respondents. Respondents who reported experience with traditional Korean medicine hospitals were more likely to prefer a one-stop treatment approach than those who did not have experience with traditional Korean medicine hospitals (adjusted odds ratio: 1.73; 95% confidence interval: 1.12–2.68). Respondents who were familiar with collaborative treatment but did not report any personal experience with it were more likely to prefer a one-stop treatment approach than those who were not familiar with collaborative treatment (adjusted odds ratio: 1.82; 95% confidence interval: 1.37–2.44).

Koreans prefer a concurrent type of collaborative treatment system by KMDs and medical doctors. Therefore, efforts and support are needed to increase the application of the concurrent type of collaborative system.
Treatment for overactive bladder
Authors: Yang Ding-Yuan , Zhao Liu-Ni , Qiu Ming-Xing
Published: May 2021

Background:

We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder.

Methods:

A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses.

Results:

A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = −0.65, 95% confidence interval [CI]: −1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: −0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: −0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = −0.14, 95% CI: −0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group.

Conclusion:

Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.
Biomarkers involved in evaluation of platelets function in South-Eastern Romanian patients with hematological malignancies subtypes
Authors: Matei Elena , Aschie Mariana , Mitroi Anca Florentina , Ghinea Mihaela Maria , Gheorghe Emma , Petcu Lucian , Dobrin Nicolae , Chisoi Anca , Mihaela Manea
Published: May 2021

At present, various researches presented how subtypes of hematological malignancies are related to stages of the immune response, because the activated immune system represents a promising form in cancer treatment. This study explores the relationship between the adaptive immune system (T cells), and the coagulation system (platelets, platelet membrane glycoproteins, platelets derivate microparticles) which seems to play an important role in host immune defense of patients with acute myeloblastic leukemia (AML) or B cell lymphoma (BCL), 2 of the most common hematological malignancies subtypes.

Blood samples (n = 114) obtained from patients with AML or BCL were analyzed for platelet membrane glycoproteins (CD42b, CD61), glycoprotein found on the surface of the T helper cells (CD4+), protein complex-specific antigen for T cells (CD3+), platelet-derived microparticles (CD61 PMP) biomarkers by flow cytometry, and hematological parameters were quantified by usual methods.

In patients with AML, the means of the percentage of the expressions of the molecules on platelet surfaces (CD61 and CD42b, P < .01; paired T test) were lower as compared to both control subgroups. The expression of cytoplasmic granules content (CD61 PMP) had a significantly higher value in patients with AML reported to controlling subgroups (P < .01; paired T test), which is suggesting an intravascular activation of platelets.

The platelet activation status was presented in patients with low stage BCL because CD61 and CD42b expressions were significantly higher than control subgroups, but the expression of CD 61 PMP had a significantly decreased value reported to control subgroups (all P < .01; paired T test). T helper/inducer lineage CD4+ and T lymphoid lineage CD3+ expressions presented significant differences between patients with AML or low stage BCL reported to control subgroups (all P < .01; paired T test).

Platelet–lymphocyte interactions are involved in malignant disorders, and CD61, CD42b present on platelet membranes, as functionally active surface receptors mediate the adhesion of active platelets to lymphocytes, endothelial cells, and cancer cells.
Spontaneous rupture of a renal artery pseudoaneurysm in a hemodialysis patient
Authors: Lee Seunghye , Jung Sehyun , Kim Hyun-Jung , Jang Ha Nee , Park Dong Jun , Bae Eunjin , Lee Tae Won , Chang Se-Ho
Published: May 2021

Rationale:

Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported.

Patient concerns:

A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior.

Diagnosis:

Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms.

Interventions:

On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed.

Outcomes:

Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization.

Lessons:

When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.
ALK-negative lung inflammatory myofibroblastic tumor in a young adult
Authors: Debonis Silvia Angela , Bongiovanni Alberto , Pieri Federica , Fausti Valentina , De Vita Alessandro , Riva Nada , Gurrieri Lorena , Vanni Silvia , Diano Danila , Mercatali Laura , Ibrahim Toni
Published: May 2021

Rationale:

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor that is prevalent among children and adolescents. Surgery is the most important therapeutic approach for IMT and complete resection is recommended. Although 50% of IMTs show anaplastic lymphoma kinase (ALK) rearrangements, crizotinib has proven an effective therapeutic approach. However, the genetic landscape of this tumor is still not fully understood and treatment options are limited, especially in the majority of ALK-negative tumors.

Patient concerns:

We describe the clinical case of a healthy 18-year-old female in whom a pulmonary nodule was incidentally detected

Diagnoses:

Following a small increase in the size of the nodule, the patient underwent both 18FDG-PET/CT and 68Ga-PET/CT, resulting in a suspicion of bronchial hamartoma.

Interventions:

The patient underwent surgery and a salivary gland-like lung tumor was diagnosed.

Outcomes:

After surgery, the patient was referred to our cancer center, where a review of the histology slides gave a final diagnosis of ALK-negative lung IMT. Given the histology, it was decided not to administer adjuvant therapy and the patient was placed in a 3-monthly follow-up program. The patient is still disease-free 2 years post-surgery.

Lessons:

Although there is no standard of care for the treatment of IMT, identifying genomic alterations could help to redefine the management of patients with negative-ALK disease. Our review of the literature on IMT and other kinase fusions revealed, in addition to ALK rearrangements, the potential association of ROS1, NTRK, RET, or PDGFR beta alterations with the tumor.
Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration
Authors: Liu Wei , Wang Yongxue , Zhang Weidong , Wu Huaiqiu , Liu Zhiguang
Published: May 2021

Introduction:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen).

Patient concerns:

A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed.

Diagnosis:

The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid.

Interventions:

Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed.

Outcomes:

Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic.

Conclusions:

EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.
Clinical characteristics, triggering etiologies, and response of plasmapheresis in thrombotic microangiopathy in Taiwan
Authors: Chung Ching-Hu , Tsai I-Jung , Tseng Min-Hua , Chou Hsin-Hsu , Tain You-Lin , Tsai Jeng-Daw , Chiou Yuan-Yow , Chiou Yee-Hsuan , Lin Ching-Yuang
Published: May 2021

Thrombotic microangiopathy (TMA) syndromes are extraordinarily diverse in clinical presentations and etiologies. However, there are still a limited number of large cohort studies focusing on the underlying causes, outcomes, and response to plasmapheresis.

A retrospective study was designed to understand trigger etiologies, organ dysfunctions, clinical outcomes, and efficacy of plasmapheresis in patients with TMA. The whole population of Taiwan was set up into 2 cohorts: 875 patients with TMA in the 2006 cohort (2006–2010) and 1352 patients with TMA in the 2011 cohort (2011–2015). One hundred ninety-five patients in the 2006 cohort and 272 patients in the 2011 cohort were under plasmapheresis treatment.

The common underlying etiologies were pregnancy, followed by systemic lupus erythematosus, rheumatoid arthritis, transplantation and drugs, which were significantly higher than the control group. Stroke, seizure, arterial thrombosis, vascular stenosis, hypertension, myocardial infarction, and pancreatitis were the main clinical signs and extra-renal involvements. In the multivariate regression analysis, stroke, arterial thrombosis, peripheral arterial disease, and uremia were significantly higher compared with the control group. The mortality rate in TMA under plasmapheresis was significantly higher than all TMA cases (39.33% vs 15.39% in the 2006 cohort and 39.27% vs 15.06% in the 2011 cohort).

This study indicated the spectrum of underlying causes, extra-renal characteristics, and the response to plasmapheresis of patients with TMA in Taiwan. Of note, the poor clinical outcomes of plasmapheresis in patients with TMA might highlight the masked underlying etiology or worse disease condition that should be noticed.
Wound complications after primary and repeated midline, transverse and modified Makuuchi incision
Authors: Hempel Sebastian , Kalauch Anne , Oehme Florian , Wolk Steffen , Welsch Thilo , Weitz Jürgen , Distler Marius
Published: May 2021

There are 3 main types of incisions in major open, elective abdominal surgery: the midline incision (MI), the transverse incision (TI) and the modified Makuuchi incision (MMI). This study aimed to compare these approaches regarding wound complications and hernias, with a special focus on suture material and previous laparotomies.

Patients who underwent elective abdominal surgery between 2015 and 2016 were retrospectively analyzed. Uni- and multivariate analyses were computed using stepwise binary and multifactorial regression models.

In total, 696 patients (406 MI, 137 TI and 153 MMI) were included. No relevant differences were observed for patient characteristics (e.g., sex, age, body mass index [BMI], American Society of Anesthesiologists [ASA] score). Fewer wound complications (TI 22.6% vs MI 33.5% vs MMI 32.7%, P = .04) occurred in the TI group. However, regarding the endpoints surgical site infection (SSI), fascial dehiscence and incisional hernia, no risk factor after MI, TI, and MMI could be detected in statistical analysis. There was no difference regarding the occurrence of fascial dehiscence (P = .58) or incisional hernia (P = .97) between MI, TI, and MMI. In cases of relaparotomies, the incidence of fascial dehiscence (P = .2) or incisional hernia (P = .58) did not significantly differ between the MI, TI, or MMI as well as between primary and reincision of each type. On the other hand, the time to first appearance of a hernia after MMI is significantly shorter (P = .03) than after MI or TI, even after previous laparotomy (P = .003).

In comparing the 3 most common types of abdominal incisions and ignoring the type of operative procedure performed, TI seems to be the least complicated approach. However, because the incidence of fascial dehiscence and incisional hernia is not relevantly increased, the stability of the abdominal wall is apparently not affected by relaparotomy, even by repeated MIs, TIs, and MMIs. Therefore, the type of laparotomy, especially a relaparotomy, can be chosen based on the surgeon's preference and planned procedure without worrying about increased wound complications.
Prone position versus supine position in postoperative radiotherapy for breast cancer
Authors: Lai Junming , Zhong Fangyan , Deng Jianxiong , Hu Shuang , Shen Ruoyan , Luo Hui , Luo Yongbiao
Published: May 2021

Background:

This meta-analysis evaluates the difference of sparing organs at risk (OAR) in different position (Prone position and Supine position) with different breathing patterns (Free breathing, FB/Deep inspiration breath hold, DIBH) for breast cancer patients receiving postoperative radiotherapy and provides a useful reference for clinical practice.

Method:

The relevant controlled trials of prone position versus supine position in postoperative radiotherapy for breast cancer were retrieved from the sources of PubMed, Cochrane Library, Embase, Web of Science and ClinicalTrails.gov. The principal outcome of interest was OAR doses (heart dose, left anterior descending coronary artery dose and ipsilateral lung dose) and target coverage. We mainly compared the effects of P-FB (Prone position FB) and S-FB (Supine position FB) and discussed the effects of DIBH combined with different positions on OAR dose in postoperative radiotherapy. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.4 software.

Results:

The analysis included 751 patients from 19 observational studies. Compared with the S-FB, the P-FB can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and ipsilateral lung dose (ILL) more effectively, and the difference was statistically significant (heart dose, SMD = − 0.51, 95% CI − 0.66 ∼ − 0.36, P < .00001. LADCA dose, SMD = − 0.58, 95% CI – 0.85 ∼ − 0.31, P < .0001. ILL dose, SMD = − 2.84, 95% CI − 3.2 ∼ − 2.48, P < .00001). And there was no significant difference in target coverage between the S-FB and P-FB groups (SMD = − 0.1, 95% CI − 0.57 ∼ 0.36, P = .66). Moreover, through descriptive analysis, we found that P-DIBH (Prone position DIBH) has better sparing OAR than P-FB and S-DIBH (Supine position DIBH).

Conclusion:

By this meta-analysis, compared with the S-FB we found that implementation of P-FB in postoperative radiotherapy for breast cancer can reduce irradiation of heart dose, LADCA dose and ILL dose, without compromising mean dose of target coverage. Moreover, P-DIBH might become the most promising way for breast cancer patients to undergo radiotherapy.
Efficacy and safety of Linggui Zhugan decoction in the treatment of chronic heart failure with Yang deficiency
Authors: Li Yumeng , Wu Huaqin , Zhang Bingxuan , Xu Xia , Wang Yajiao , Song Qingqiao
Published: May 2021

Background:

Chronic heart failure (CHF) is an advanced stage of various heart diseases and has become a major global health problem. In 2018, the Chinese guideline for the diagnosis and treatment of HF suggested adding traditional Chinese medicine (TCM) as an adjunct to the treatment of CHF, but also pointed out the need for more convincing clinical evidences. Linggui Zhugan decoction (LGZGD) is one of the widely used TCM for CHF treatment, especially for patients with Yang deficiency. Given that treatment based on syndrome differentiation is an important principle in TCM, we provide a protocol to systematically evaluate efficacy and safety of LGZGD for CHF with Yang deficiency.

Methods:

We will search the following electronic databases from inception to April 30, 2021, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, VIP Information Database, Chinese Biomedical Literature Database (CBM), and Wanfang Database. Randomized controlled trials (RCT) examining the LGZGD on CHF patients with Yang deficiency will be included. Study selection, data extraction and quality assessment will be conducted by 2 researchers, respectively. The primary outcome measures will be n-terminal brain natriuretic peptide and left ventricular ejection fraction. The risk of bias will be evaluated by the Cochrane Collaboration tool. We will use the fixed-effects model or random-effects model of RevMan V.5.3 based on the results of heterogeneity assessment. The evidence quality of results will be assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results:

It will provide the results about efficacy and safety of LGZGD in the treatment of CHF with Yang deficiency by various comprehensive assessments.

Conclusions:

This study will provide reliable evidences about the efficacy and safety of LGZGD in the treatment of CHF with Yang deficiency.

Ethics and dissemination:

Ethical approval is not necessary for this study because the data extracted does not involve any individual privacy. We plan to presented the results of this review in a peer-reviewed journal.

PROSPERO registration number:

CRD 42019140797.
An interventional study on the influence of social and family support systems on the fertility pattern of HIV-infected women
Authors: Chen Shaoping , Ning Yifang , Tan Yunhuan , Lin Xiaoli , Wang Miao
Published: May 2021

Objectives:

This study was designed to explore the influence of social and family support system on the fertility pattern of human immunodeficiency virus (HIV)-infected women.

Trial design:

An interventional study including 70 participants.

Methods:

HIV-infected female participants treated from January 2015 to January 2019 were selected, randomly divided into 2 groups, with 35cases in each group. The experimental group was given complete social and family support, whereas the control group was given basic treatment only. Changes in fertility rate, fertility number, and fertility interval were compared between the 2 groups. We also compared the changes in the quality of life (QOL), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) of the 2 groups of participants.

Results:

The fertility rate of the experimental group was 43.29%, and that of in the control group was 31.96%, and the childbearing age is mainly concentrated in the 20 to 29 years; the difference was statistically significant (P < .05). The mean number of births in the experimental group was (1.47 ± 0.61), which was significantly higher than that of in the control group (0.63 ± 0.22), and the difference was statistically significant (P < .05). The fertility interval of the experimental group was significantly lower than that of in the control group (2.65 ± 1.34 vs 3.77 ± 0.85), and the difference was statistically significant (P < .05). Before the intervention, there were no significant differences in the QOL scores, SAS, and SDS scores between the experimental group and the control group (P > 0.05). After intervention, the scores of QOL in the experimental group was significantly higher than those of in the control group (54.1 ± 1.7 vs 41.2 ± 2.5); the SAS and SDS scores of the experimental group were significantly lower than those of in the control group (39.3 ± 4.2 vs 56.1 ± 5.7; 32.2 ± 6.7 vs 51.9 ± 5.8), and the difference were statistically significant (P < .05).

Conclusions:

Social and family support for female participants infected with HIV can improve the fertility rate of women to some extent, increase the number of births and shorten the interval between births, and can help relief the women's anxiety, depression, and other emotional problems, which is worthy of extensive application and promotion in the society.
Occupational stress among Nigerian construction trade artisans in the building construction sector
Authors: Omeje Hyginus Osita , Okereke Godwin Keres Okoro , Asogwa Japel Onyekachi , Obe Pauline Ijeoma , Nwaodo Samson Ikenna , Ariyo Samson Oluwatimilehin , Okanya Victor Arinzechukwu , Vincent Deborah Ahuoiza , Chukwu Daniel Uchenna , Ike Joshua Onyedikachi , Udogu Kingsley Chimezia , Ugwuanyi Christian Sunday , Aneke Mary
Published: May 2021

Background:

Construction work can negatively affect artisans’ mental health in the form of stress. This research investigated the effect of cognitive behavioral intervention on occupational stress among Nigerian construction trade artisans in the building construction sector.

Methods:

In this randomized controlled study involving 3 waves of data collection, 140 construction trade artisans who presented with high occupational stress symptoms at the study onset were assigned randomly to either a treatment condition (n = 70) or to a waitlist control condition (n = 70). The study involved pre-treatment and post-treatment assessments and a 3-months follow-up. The artisans’ occupational stress questionnaire and artisans’ dysfunctional thoughts at work scale were the data collection instruments.

Results:

Results revealed a significant effect of group on artisans’ occupational stress and dysfunctional thoughts at work. Also, significant effects of time on artisans’ occupational stress and dysfunctional thoughts at work were recorded. Finally, group × time interaction effects on artisans’ occupational stress and dysfunctional thoughts at work were significant.

Conclusion:

Cognitive behavioral intervention effectively reduced occupational stress symptoms and dysfunctional thoughts at work among Nigerian construction trade artisans compared with a waitlist control condition.
A 3-DNA methylation signature as a novel prognostic biomarker in patients with sarcoma by bioinformatics analysis
Authors: Wang Xiao-Wei , Sun Qi , Xu Shi-Bin , Xu Chao , Xia Chen-Jie , Zhao Qi-Ming , Zhang Hua-Hui , Tan Wei-Qiang , Zhang Lei , Yao Shu-Dong
Published: May 2021

Background:

Tumor-specific DNA methylation can potentially be a useful indicator in cancer diagnostics and monitoring. Sarcomas comprise a heterogeneous group of mesenchymal neoplasms which cause life-threatening tumors occurring throughout the body. Therefore, potential molecular detection and prognostic evaluation is very important for early diagnosis and treatment.

Methods:

We performed a retrospective study analyzing DNA methylation of 261 patients with sarcoma from The Cancer Genome Atlas (TCGA) database. Cox regression analyses were conducted to identify a signature associated with the overall survival (OS) of patients with sarcoma, which was validated in a validation dataset.

Results:

Three DNA methylation signatures were identified to be significantly associated with OS. Kaplan–Meier analysis showed that the 3-DNA methylation signature could significantly distinguish the high- and low-risk patients in both training (first two-thirds) and validation datasets (remaining one-third). Receiver operating characteristic (ROC) analysis confirmed that the 3-DNA methylation signature exhibited high sensitivity and specificity in predicting OS of patients. Also, the Kaplan–Meier analysis and the area under curve (AUC) values indicated that the 3-DNA methylation signature was independent of clinical characteristics, including age at diagnosis, sex, anatomic location, tumor residual classification, and histological subtypes.

Conclusions:

The current study showed that the 3-DNA methylation model could efficiently function as a novel and independent prognostic biomarker and therapeutic target for patients with sarcoma.
Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?
Authors: Elnasser Ziad A. , Obeidat Haneen M. , Bani-Salem Mo’ath E. , Amarin Zouhair O. , Banni-Issa Ali F. , Kaplan Nasser M.
Published: May 2021

Ventilator-associated pneumonia is a life threatening device related infection in intensive care units. Methicillin-resistant Staphylococcus aureus is considered a common contagious pathogen causing pneumonia and sepsis.

To assess the prevalence of S aureus in comparison to other pathogens, and their antibacterial sensitivity profile in ventilator-associated pneumonia.

Data regarding ventilator-associated pneumonia of adults admitted to the intensive care unit, at the Jordan University of Science and Technology Hospital, between 2012 and 2018 were extracted from the computerized system. Microorganisms and their susceptibility profiles were identified according to the Clinical and Laboratory Standards Institute.

There were 547 isolates, of which 35 (6.4%) were Gram positive, 59% were methicillin resistant. Gram-negative isolates were present in 507 (92.6%) isolates, of which 82% were multidrug resistant, and 1% were Candida species.

Gram-negative bacterial infections were significantly associated with ventilation usage. S aureus was not the predominant pathogen.
Efficacy and safety of ticagrelor monotherapy in patients following percutaneous coronary intervention
Authors: Zhang Wen-bin , Liu Li-nan , Liu Yang , Wang Zhen
Published: May 2021

Background:

We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention.

Methods:

Online databases were searched for relevant studies (published between the years 2015 and 2020) comparing 1-month Dual antiplatelet therapy (DAPT) followed by 23-month ticagrelor monotherapy with 12-month DAPT followed by 12-month aspirin monotherapy following percutaneous coronary intervention. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software.

Results:

Only 6 studies were selected for this meta-analytical research. The meta-analysis results: MI(OR:0.96, 95% CI:0.86–1.06, P = .40), stroke (OR:1.04, 95% CI: 0.87–1.25, P = .68), stent thrombosis (OR: 0.91,95% CI:0.76–1.10,P = .32),New-Q Wave (OR:0.85,95% CI: 0.72–1.00, P = .05), all cause death (OR:0.91, 95% CI: 0.87–0.96, P < .0001), death from cardiovascular (OR: 0.76, 95% CI: 0.58–0.99, P = .04), revascularization (OR: 0.93, 95% CI: 0.87–0.99, P = .03). Ticagrelor monotherapy was associated with a significantly lower rate of myocardial Infarction (MI), stroke, stent thrombosis, all cause death, death from cardiovascular and revascularization (OR:0.91,95% CI:0.87–0.96, P < .0001) when compared to DAPT. Besides, DAPT was associated with a significantly higher rate of BARC3 or 5 bleeding (OR:0.85, 95% CI: 0.68–1.06; P = .16) when compared to ticagrelor. When bleeding was further subdivided, minor or major bleeding was also significantly higher with DAPT (OR: 0.72, 95% CI: 0.41–1.27; P = .26). GUSTO moderate or severe bleeding was also significantly higher with DAPT (OR: 0.77, 95% CI: 0.39–1.52; P = .45).

Conclusion:

Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) can optimize ischemic and bleeding risks. And, it can reduce the occurrence of events outcome (MI, revascularization, stroke, stent thrombosis).
A combination of herbal formulas, acupuncture, and novel pine-needle stimulation for recurrent alopecia areata
Authors: Kawashima Nozomu , Hu Xiaochen , Ishikawa Nagako , Matsuhisa Takaharu , Sato Juichi
Published: May 2021

Introduction:

Head hair is a symbol of vitality, and hair loss by alopecia areata (AA) presents a burden on patients. Although traditional Japanese Kampo medicine (JKM) formulas, acupuncture, and moxibustion have historically been used for treating AA, no studies have utilized a combination of these modalities.

Patient concerns:

A 34-year-old male with a history of childhood asthma presented with a sudden hair loss at the top of his head without any preceding symptoms. Except for a hairless patch of 5 cm × 6 cm, his general appearance was otherwise good. The patient underwent topical immunotherapy on visiting a dermatologist. However, the patient noticed an exacerbation of his hairless lesion.

Diagnosis:

The AA diagnosis was established based on clinical appearance and dermatological findings. The Severity of Alopecia Tool (SALT) score for alopecia was 19% at diagnosis.

Interventions:

The patient received 2 JKM formulas (saikokaryukotsuboreito and shichimotsukokato) in combination with acupuncture. When relapse occurred, a novel self-administration of pine-needle acupuncture was initiated in combination with the JKM formulas.

Outcomes:

A 50% recovery from the baseline SALT score was achieved using JKM formulas in combination with acupuncture for 4 months. The patient achieved complete remission for 5 months. However, another stressful event induced an AA relapse with multiple lesions harboring a SALT score of 13%. Pine-needle acupuncture was initiated, resulting in faster resolution than the first treatment. Recoveries of 50% and 75% were achieved 3 and 4 months after relapse, respectively, and a long-lasting response without relapse was obtained for at least 3 years.

Conclusion:

A combination of multimodal traditional therapies, including JKM formulas, acupuncture, and self-administered pine-needle stimulation, represents an effective integrative treatment for patients with AA.
Unilateral cerebral cortical encephalitis (CCE) with positive anti-MOG antibodies
Authors: Nie Hongbing , Gao Haifeng , Li Yongqiu , Shen Yaoyao
Published: May 2021

Rationale:

Nowadays, myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease (MOGAD) is regarded as an independent inflammatory demyelinating disease. Here, we report a rare case of unilateral cerebral cortical encephalitis (CCE) with positive anti-MOG antibodies.

Patient concerns:

A 19-year-old woman was admitted to our hospital owing to acute onset fever and headache. Four days later, she experienced a focal seizure that progressed to generalized tonic-clonic seizures.

Diagnosis:

Brain magnetic resonance imaging (MRI) demonstrated cortical lesions in the left cerebral hemisphere on T2-weighted fluid-attenuated inversion recovery imaging. The patient was positive for anti-MOG antibodies in serum and diagnosed with anti-MOG antibody-associated unilateral CCE.

Interventions:

She was administrated with intravenous methylprednisolone followed by oral corticosteroids.

Outcomes:

On day 14 after admission, a repeat MRI revealed partial resolution of the initial abnormalities. The patient received a quick recovery without residual symptoms.

Conclusions:

Unilateral CCE with positive anti-MOG antibodies has emerged as a special clinical phenotype of MOGAD. It should be emphasized that the characteristic neuroradiological features of CCE would be an important clue to the correct diagnosis of MOGAD.
Multimaterial decomposition algorithm for quantification of fat in hepatocellular carcinoma using rapid kilovoltage-switching dual-energy CT
Authors: Ota Takashi , Hori Masatoshi , Sasaki Kosuke , Onishi Hiromitsu , Nakamoto Atsushi , Tatsumi Mitsuaki , Fukui Hideyuki , Ogawa Kazuya , Tomiyama Noriyuki
Published: May 2021

Understanding intratumoral fat in hepatocellular carcinoma (HCC) is clinically important to elucidate prognosis. We sought to quantify HCC and liver fat with a multimaterial decomposition (MMD) algorithm with rapid kilovoltage-switching dual-energy computed tomography (DECT) relative to chemical-shift magnetic resonance imaging (CSI).

In this retrospective study, 40 consecutive patients with HCC underwent non-contrast-enhanced (non-CE) and four-phases contrast-enhanced (four-CE) DECT (80 and 140 kVp) and abdominal MR imaging (including CSI) between April 2011 and December 2012. Fat volume fraction (FVFDECT) maps were generated by MMD algorithm to quantify HCC and liver fat. Fat fraction measured by CSI (FFCSI) was determined for HCC and liver on dual-echo sequence using 1.5- or 3-Tesla MR systems. The correlation between FVFDECT and FFCSI was evaluated using Pearson correlation test, while non-CE FVFDECT and four-CE FVFDECT were compared by one-way ANOVA and Bland–Altman analysis.

Forty patients (mean age, 70.1 years ± 7.8; 25 males) were evaluated. FVFDECT and FFCSI exhibited weak to moderate correlations for HCC in non-CE and four-CE except in equilibrium phase (r = 0.42, 0.44, 0.35, and 0.33; all P < .05), and very strong correlations for liver in all phases (r = 0.86, 0.83, 0.85, 0.87, and 0.84; all P < .05). Those correlation coefficients were significantly higher for liver for each phase (all P < .05). FVFDECT did not differ significantly across scan phases regarding HCC or liver (P = .076 and 0.56). Bland–Altman analysis showed fixed bias in all phases between non- and four-CE FVFDECT in HCC and liver.

As compared with liver, correlations between FVF measured by DECT-based MMD and FF measured by CSI were weak in HCC in all phases. FVF is reproducible across all scan phases in HCC and liver. The MMD algorithm requires modification for HCC fat quantification given the heterogeneous components of HCC.
Repeat injection following sentinel node nonvisualization on lymphoscintigraphy images can decrease axillary dissection rate in breast cancer patients
Authors: Aghaee Atena , Soltani Ehasn , Jangjoo Sara , Asadi Mehdi , Dabbagh Kakhki Vahid Reza , Sadeghi Ramin
Published: May 2021

Aim

Sentinel node biopsy is considered the standard of care in early-stage breast cancer patients. In the current study, we evaluated the effect of radiotracer reinjection in the case of sentinel node nonvisualization on preoperative lymphoscintigraphy.

Materials and methods

Between March 2017 and March 2020, 1850 early-stage breast cancer patients were referred for sentinel node mapping. All patients received a single injected activity of Tc-99m Phytate intradermally in the periareolar area of the index lesion using an insulin syringe. Lymphoscintigraphy images of the patients were done 1–2 h postinjection. Between March 2017 and September 2017, sentinel node nonvisualization was reported to the surgeon, and for the rest of the study period, the patients received another injected activity of the radiotracer, and immediately, other lymphoscintigraphy images were taken (with the same parameters).

Results

A total of 255 patients entered our study. Fifty-five patients were in group I without any reinjection. The remainder of the patients were in group II. In 155 out of 200 patients of group II, a sentinel node could be visualized following reinjection of the radiotracer. The detection rate was 15 out of 45 and 15 out of 55 in group I and patients without sentinel node visualization even after reinjection, respectively. Axilla was involved in 5 out of 40 (12.5%) patients in group I with intraoperative sentinel node mapping failure. On the other hand, axilla was involved in 27 out of 30 (90%) group II patients with sentinel node nonvisualization.

Conclusion

Reinjection of the tracer in cases of no sentinel node visualization in lymphoscintigraphy for breast cancer increases the detection rate of sentinel nodes, and therefore a high number of unnecessary axillary lymph node dissections can be avoided.