bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally invasive approach with external fixator for intra-articular calcaneal fractures in children
Authors: Li Jin , Jin Rui , Ze Renhao , Rai Saroj , Liu Yudong , Tang Xin , Liu Ruikang , Hong Pan
Published: January 2021

Calcaneal fractures are rare in pediatric population, with more displaced intra-articular fractures encountered due to the increasing number of high-energy trauma. Operative interventions are gaining popularity because of the unsatisfactory outcomes of traditional conservative methods. This study investigated the clinical outcomes of a minimally invasive technique using the sinus tarsi approach and external fixator in the treatment of intra-articular calcaneal fractures in pediatric patients.

Patients who underwent open reduction between January 2010 and January 2018 at our institute were included in this study and reviewed retrospectively. Radiological and clinical parameters were all recorded and analyzed.

Overall, 29 patients were included in the study, including 23 boys and 6 girls (10.2 ± 2.2 years old). The average follow-up was 29.5 months postoperatively (range, 26–72 months). Bohler angle was 15.2 ± 3.3° preoperatively, and 34.0 ± 3.8° postoperatively (P < .001); Gissane angle was 101.8 ± 6.2 degrees preoperatively, and 129.7 ± 6.2° postoperatively (P < .001). The average length of incision was 3.4 ± 0.7 cm. At the last follow-up, all patients showed satisfactory clinical outcomes and the score was 90.0 ± 2.3 according to American Orthopedic Foot and Ankle Society Scale.

Minimally invasive approach with external fixator is an effective method for treating displaced intra-articular calcaneal fractures in pediatric patients, with a lower incidence of wound-related complications and good cosmetic outcomes.
A novel mutation in RAB3GAP1 gene in Chinese patient causing the Warburg micro syndrome
Authors: Zhou Dan , Wang Qiu , Liu Hanmin
Published: January 2021

Rationale:

Warburg Micro syndrome is a rare, autosomal recessive disorder characterized by multiple organ abnormalities involving the ocular, nervous, and genital systems. This case report describes a novel mutation in the RAB3GAP1 gene associated with Warburg Micro syndrome.

Patient concerns:

A 6-month-old female infant with bilateral congenital cataracts and developmental delay was referred to our department for further assessment. She presented with facial dysmorphic features, including a prominent forehead, microphthalmia, wide nasal bridge, relatively narrow mouth, large anteverted ears, and micrognathia.

Diagnoses:

The patient was diagnosed with Warburg Micro syndrome based on clinical manifestations, as well as a novel homozygous mutation in RAB3GAP1: c.75–2A>C. Both parents were identified as heterozygotic carriers of this mutation.

Interventions:

Bilateral cataract extraction and anterior vitrectomy were performed at age 6 months, followed by physical rehabilitation. Convex lenses were used to protect the eyes postoperatively until intraocular lens implantation.

Outcomes:

Although the patient received physical rehabilitation, she suffered global developmental delay.

Lessons:

The c.75–2A>C mutation in RAB3GAP1 expands the spectrum of known mutations in this gene, and it may be associated with Warburg Micro syndrome. Genetic counselors may wish to take this finding into consideration, especially given the poor prognosis associated with the disease.
Utility of a simplified ultrasonography scoring system among patients with rheumatoid arthritis
Authors: Endo Yushiro , Kawashiri Shin-ya , Morimoto Shimpei , Nishino Ayako , Okamoto Momoko , Tsuji Sosuke , Takatani Ayuko , Shimizu Toshimasa , Sumiyoshi Remi , Igawa Takashi , Koga Tomohiro , Iwamoto Naoki , Ichinose Kunihiro , Tamai Mami , Nakamura Hideki , Origuchi Tomoki , Ueki Yukitaka , Yoshitama Tamami , Eiraku Nobutaka , Matsuoka Naoki , Okada Akitomo , Fujikawa Keita , Otsubo Hideo , Takaoka Hirokazu , Hamada Hiroaki , Tsuru Tomomi , Nagano Shuji , Yojiro Arinobu , Hidaka Toshihiko , Tada Yoshifumi , Kawakami Atsushi
Published: January 2021

We aimed to evaluate the utility of a simplified ultrasonography (US) scoring system, which is desired in daily clinical practice, among patients with rheumatoid arthritis (RA) receiving biological/targeted synthetic disease-modifying antirheumatic drugs (DMARDs).

A total of 289 Japanese patients with RA who were started on tumor necrosis factor inhibitors, abatacept, tocilizumab, or Janus kinase inhibitors between June 2013 and April 2019 at one of the 15 participating rheumatology centers were reviewed. We performed US assessment of articular synovia over 22 joints among bilateral wrist and finger joints, and the 22-joint (22j)-GS and 22-joint (22j)-PD scores were evaluated as an indicator of US activity using the sum of the GS and PD scores, respectively.

The top 6 most affected joints included the bilateral wrist and second/third metacarpophalangeal joints. Therefore, 6-joint (6j)-GS and -PD scores were defined as the sum of the GS and PD scores from the 6 synovial sites over the aforementioned 6 joints, respectively. Although the 22j- or 6j-US scores were significantly correlated with DAS28-ESR or -CRP scores, the correlations were weak. Conversely, 6j-US scores were significantly and strongly correlated with 22j-US scores not only at baseline but also after therapy initiation.

Using a multicenter cohort data, our results indicated that a simplified US scoring system could be adequately tolerated during any disease course among patients with RA receiving biological/targeted synthetic DMARDs.
Anti-IL6 treatment of serious COVID-19 disease
Authors: Castelnovo Laura , Tamburello Antonio , Lurati Alfredo , Zaccara Eleonora , Marrazza Maria Grazia , Olivetti Micol , Mumoli Nicola , Mastroiacovo Daniela , Colombo Daniele , Ricchiuti Elisabetta , Vigano’ Paolo , Paola Faggioli , Mazzone Antonino
Published: January 2021

COVID-19 is causing a high influx of patients suffering from serious respiratory complications leading the necessity to find effective therapies. These patients seem to present with cytokine perturbation and high levels of IL6. Tocilizumab and sarilumab could be effective in this condition.

We retrospectively collected data about 112 consecutive hospitalized in a single center.

Fifty (IL6 group) treated with tocilizumab (8 mg/kg intravenously [IV], 2 infusions 12 hours apart) or sarilumab 400 mg IV once and 62 treated with the standard of care but not anti-cytokine drugs (CONTROL group).

To determine whether anti-IL6 drugs are effective in improving prognosis and reducing hospitalization times and mortality in COVID-19 pneumonia.

To date 84% (42/50) of IL6 group patients have already been discharged and only 2/50 are still recovered and intubated in intensive care. Six/fifty patients (12%) died: 5/6 due to severe respiratory failure within a framework of severe acute respiratory distress syndrome (ARDS), 1 suffered an acute myocardial infarction, and 1 died of massive pulmonary thromboembolism. There were no adverse treatment events or infectious complications. Compared to the CONTROL group they showed a lower mortality rate (12% versus 43%), for the same number of complications and days of hospitalization.

Anti-IL6 drugs seem to be effective in the treatment of medium to severe forms of COVID-19 pneumonia reducing the risk of mortality due to multi-organ failure, acting at the systemic level and reducing inflammation levels and therefore microvascular complications. However, it is essential to identify the best time for treatment, which, if delayed, is rendered useless as well as counterproductive. Further studies and ongoing clinical trials will help us to better define patients eligible as candidates for more aggressive intervention.
Identification of an IGF1 mutation (c.15+3G>A) in familial osteonecrosis of the femoral head
Authors: Xu Qi , Song Da , Wu Zhensong , Fu Bo , Zheng Juan , Li Rongrong , Yin Han , Chen Shuangfeng , Wang Dawei
Published: January 2021

Rationale:

Osteonecrosis of the femoral head is a common orthopedic disease. Some studies have shown that osteonecrosis of the femoral head is related to susceptibility genes, but there are few reports of familial osteonecrosis of the femoral head. Here, we reported two first-degree relatives with osteonecrosis of the femoral head.

Patient concerns:

A 27-year-old man with bilateral hip pain was diagnosed with osteonecrosis of the femoral head. The patient's mother also had a history of this disease.

Diagnoses:

Whole exome sequencing revealed the same mutation (c.15+3G>A) in the insulin-like growth factor 1 (IGF1) gene of the proband and his mother but not in his elder sister.

Interventions:

The patient underwent bilateral total hip arthroplast.

Outcomes:

The patient recovered well, and was discharged.

Lessons:

We found a heterozygous mutation (c.15+3G>A) in IGF1 in this family, which could be related to osteonecrosis of the femoral head. Early genetic counseling and gene locus detection could, thus, prove helpful for early diagnosis of osteonecrosis of the femoral head.
Renshen (Panax ginseng) and Huanglian (Rhizoma Coptidis) For T2DM
Authors: Wang Shengnan , Yue Rensong , Huang Xiaoying , Li Linzhi , Xu Chenyi , Liu Longyan
Published: January 2021

Introduction:

Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by high blood sugar caused by impaired insulin action. With an increasing incidence year by year, it has become a worldwide epidemic. Because of its serious, long-term condition, T2DM has a bad impact on the life and well-being of individuals, families and society. Renshen and Huanglian or compound prescription contain Renshen and Huanglian for treatment of T2DM has already been confirmed. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on Renshen and Huanglian and provide effective evidence for further research.

Methods and analysis:

We will search English databases (PubMed, Embase, Web of Science, Nature, Science on line, the Cochrane Library) and Chinese databases (CNKI, Wan Fang, VIP, Chinese biomedical database), from the establishment of database to October 2020, for randomized controlled trials (RCTs) of ginseng and coptis and the compound containing ginseng and coptis in the treatment of T2DM. Primary outcomes: fasting blood-glucose (FBG), 2 Hours Postprandial Blood Glucose (2hPBG), Glycosylated hemoglobin A1c (HbA1c). Additional outcomes: Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), triglycerides (TG), total serum cholesterol (TC). Two researchers independently extracted the data and evaluated the quality of the included research, and meta-analysis was conducted on the included data using the software of RevMan5.3 and Stata V.12.0.

Results:

The results of this study will systematically evaluate the effectiveness and safety of Renshen and Huanglian intervention for people with T2DM.

Conclusion:

The systematic review of this study will summarize the current published evidence of Renshen and Huanglian or compound prescription contain Renshen and Huanglian for the treatment of T2DM, which can further guide the promotion and application of it.

Ethics and dissemination:

This study is a systematic review; the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations.

Open Science Framework (OSF) registration number:

October 18, 2020. osf.io/8gz7c (https://osf.io/8gz7c).
Association between miR-27a rs895819 polymorphism and breast cancer susceptibility
Authors: Liu Yuan , Gui Yi-Fei , Liao Wen-Yong , Zhang Yu-Qin , Zhang Xiao-Bin , Huang Yan-Ping , Wu Feng-Ming , Huang Zhen , Lu Yun-Fei
Published: January 2021

Background:

Polymorphism in miR-27a rs895819 has been associated with breast cancer (BC) risk, but studies have reported inconsistent results. This meta-analysis investigated the possible association between miR-27a rs895819 polymorphism and BC risk.

Methods:

PubMed, EMBASE, Google Scholar, and the Chinese National Knowledge Infrastructure (CNKI) databases were systematically searched to identify relevant studies in English and Chinese. Meta-analyses were performed to examine the association between miR-27a rs895819 and BC susceptibility.

Results:

A total of 16 case–control studies involving 6118 cases and 7042 controls were included. Analysis using five genetic models suggested no significant association between miR-27a rs895819 polymorphism and BC risk in the total population, or specifically in Asian or Chinese subpopulations. In the Caucasian subpopulation, however, the G-allele and AG genotype at rs895819 were significantly associated with decreased BC risk according to the allelic model (OR 0.90, 95% CI 0.84–0.97, P = .004) and heterozygous model (OR 0.89, 95% CI 0.81–089, P = .02), while the wild-type AA genotype was significantly associated with increased BC risk according to the dominant model (OR 1.13, 95% CI 1.03–1.24, P = .007).

Conclusion:

These results indicate that among Caucasians, the wild-type AA genotype at rs895819 may confer increased susceptibility to BC, while the G-allele and AG genotype may be protective factors. These conclusions should be verified in large, well-designed studies.
Is COVID-19 a high risk factor for lung cancer?
Authors: Wu Mingxin , Mou Ruiyu , Liu Xiaodi , Guo Shanqi , Kong Fanming , Li Xiaojiang , Jia Yingjie
Published: January 2021

Introduction:

COVID-19 has become a common threat to global human health and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Some asymptomatic patients with early-stage lung cancer who have COVID-19 receive surgical treatment but develop severe pneumonia and other complications or even experience postoperative death, and they may have a worse prognosis compared with healthy individuals infected with COVID-19. However, there is no evidence that COVID-19 is a risk factor for lung cancer patients. This systematic review aims to evaluate the incidence and prognosis of COVID-19 in lung cancer patients and provide evidence-based medical support for clinical treatment.

Methods:

We will search 6 medical databases to identify eligible studies published from the establishment of the database to the present. The quality of the included literature will be evaluated using the bias risk assessment tool in Cochrane 5.1.0, and a meta-analysis will be performed using Stata 14.0. Heterogeneity will be statistically assessed using χ2 tests.

Results:

The study will integrate existing research findings to investigate the prevalence and severity rate of patients with lung cancer infected with SARS-CoV-2 and analyze the prognosis and adverse clinical outcomes in patients with or without COVID-19.

Conclusion:

The results of this study provide evidence to support whether COVID-19 is a risk factor for lung cancer and provide guidance for clinical prevention and treatment based on the evidence obtained in light of the unpredictable threat posed by COVID-19.

Ethics and dissemination:

Ethics approval is not required for this systematic review as it will involve the collection and analysis of secondary data. The results of the review will be reported in international peer-reviewed journals.

PRORPERO registration number:

CRD42020195967.
Evaluating the impact of rehabilitation nursing intervention on quality of life in patients with burn injuries
Authors: Xiang Jun , Yang Qing , Xie Wei-Guo , Zhou Jing , Gong Xiang , Zhang Wei-Dong , Wu Hong
Published: January 2021

Background:

Despite the availability of pharmacological intervention, patients with burn injuries experience pain during the treatment of wounds. Supplementary rehabilitation nursing intervention are required to enhance the wellbeing of patients sustaining injuries from burns. The present study aims to conduct a systematic exploration of the impact of rehabilitation nursing intervention on the wellbeing in patients sustaining burn injuries.

Methods:

The electronic databases listed below will be searched systematically: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, and WanFang database. All the databases will be searched from their inauguration to November 2020. There will be no language constraints. Independent undertaking by 2 authors will select studies, extract data from selected studies, and assess the quality of the included studies. All disagreements will be resolved through discussion, or by consulting a third independent author. This study will make use of RevMan 5.3 software to perform statistical analysis.

Results:

The present protocol summarizes high-quality evidence to assess the impact of rehabilitation nursing intervention on the wellbeing of patients sustaining burn injuries.

Conclusion:

The results of the present protocol has the potential to present evidence to assess whether rehabilitation nursing intervention can enhance the wellbeing of patients sustaining burn injuries.

Registration number:

November 17, 2020.osf.io/t6b8c/. (https://osf.io/t6b8c/).
The effectiveness and safety of nicorandil in the treatment of patients with microvascular angina
Authors: Zhang Ye , Wang Xiaojuan , Liu Ruijuan , Li Qingsheng , Tian Wei , Lei Hong , Shi Conghong
Published: January 2021

Background:

Microvascular angina has become a clinical and frequent cardiovascular disease in recent years, which is complicated and there is no clear treatment. Today, Western medicine still deals with microvascular angina with standardized treatment based on the stable angina. Firstly, it is to control the risk factors of atherosclerosis, and the second is to reduce the oxygen consumption of the patient's heart muscle. In the previous randomized controlled clinical trials, it has shown that nicorandil can improve the symptoms of angina for the treatment of microvascular angina, but there is a lack of high-quality randomized controlled trials on the clinical effectiveness and safety of nicorandil in the treatment of microvascular angina, and the lack of evaluation of its effectiveness and safety. Therefore, this paper aims to understand whether nicorandil can further improve the prognosis of patients with microvascular angina and the safety of the drug through the method of systematic evaluation.

Methods:

Retrieval of relevant network electronic databases by computer: SinoMed, CNKI, WanFang Data, VIP, PubMed, EMbase and The Cochrane Library, the retrieval time is from the establishment of each database to December 2017, to collect randomized controlled studies of nicorandil in the treatment of microvascular angina. At the same time, it is supplemented by manual search of the included literature references, as far as possible to increase the included literature imformation. Two researchers independently browse the topics and abstracts, and select, find, read the full text of the relevant literature, and screen the literature according to the criteria for inclusion and exclusion established in advance, then extract the data, and cross-check, and resolve the differences through multi-person discussion. Data analysis of collected information is performed by using RevMan 5.3 software.

Results:

The data of the included literature are statistically analyzed by meta-analysis, and the key outcome indicators are used to determine whether nicorandil can further improve the prognosis of patients with microvascular angina and the safety of the drug.

Conclusion:

Through the method of evidence-based medicine, this study finds the existing problems and defects in the current research, which will provide high-quality evidence-based medical evidence for nicorandil's treatment of microvascular angina, and it help the clinical treatment and further research.

OSF registration number:

DOI 10.17605/OSF.IO/DSQG9.
Diagnosis of intrahepatic cholangiocarcinoma by Raman spectroscopy provides high efficiency
Authors: Jin Hongyu , Zhang Man , Huang Libin , Hao Jianqi , Zhou Lingyun
Published: January 2021

Background:

We aim to evaluate the efficiency of Raman spectroscopy (RS) in diagnosing suspected patients with intrahepatic cholangiocarcinoma (ICC), manifested by diagnostic sensitivity, specificity, and accuracy.

Methods:

We will research widely the articles concerning the use of RS in ICC through authenticated database including PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library, and CNKI between January 2012 and November 2020, retrieving at least 1500 spectra with strict criteria. This study will be carried out in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We are going to summarize the test performance using random effects models.

Results:

Based on the pooled sensitivity, specificity, and diagnostic accuracy, we intend to provide the relative diagnostic efficiency in ICC through RS.

Conclusion:

Through this systematic review and meta-analysis, we intend to provide the pooled sensitivity, specificity and diagnostic accuracy of RS in the diagnosis of suspected ICC. Other parameters like positive likelihood ratios (LR), negative LR, diagnostic odds ratio (DOR), and area under curve (AUC) of the summary receiver operating characteristics (SROC) curve will also be calculated and related figures will be drawn to help illustrate the efficacy of RS in the diagnosis of ICC.
Efficacy and safety of Xianling Gubao capsule in treating postmenopausal osteoporosis
Authors: Lou Fanglian , Xian Siping , Shu ZhongJun , Zheng Zhouhai
Published: January 2021

Background:

postmenopausal osteoporosis is a systemic metabolic skeletal disease associated with menopause-related estrogen withdrawal. postmenopausal osteoporosis is characterized by low bone mass, bone microstructure destruction, leading to increased bone brittleness and be prone to fracture, resulting in disability and death. At present, the commonly used drugs are estrogen, calcium, bone formation promoter and bone resorption inhibitor, and the side effects are obvious. In Traditional Chinese medicine, kidney-tonifying differentiating medicine is guided by the whole concept, Xianling Gubao capsule as the representative, the treatment of postmenopausal osteoporosis has certain therapeutic advantages, but lacks evidence-based medicine evidence. The purpose of this study is to systematically study the efficacy and safety of Xianling Gubao capsule in the treatment of postmenopausal osteoporosis.

Methods:

use computer to search English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China Knowledge Network, Wanfang, Weipu, Chinese Biomedical Database), in addition manually search Baidu academic, Google academic, from the establishment of database to October 2020, for randomized controlled clinical study of postmenopausal osteoporosis in the Xianling Gubao capsule treatment. Two researchers independently did the data extraction and literature quality evaluation, using RevMan5.3 software to do meta-analysis of the included literature.

Results:

this study assessed the efficacy and safety of xianling gubao capsule in the treatment of postmenopausal osteoporosis by total effective rate, bone density after treatment, blood calcium level after treatment, blood phosphorus level after treatment, pain score, quality of life and so on.

Conclusion:

this study will provide reliable evidence-based evidence for the clinical application of Xianling Gubao capsule in the treatment of postmenopausal osteoporosis.

OSF Registration number:

DOI 10.17605/OSF.IO/TP394
The efficacy of continuous nursing care for patients with chronic obstructive pulmonary disease
Authors: Guo Xue , Men Fengmin , Han Xingfen , Wang Zhenying
Published: January 2021

Background:

Chronic obstructive pulmonary disease (COPD) is a kind of disease that can be prevented and treated. It is characterized by the progressive limitation of airflow and is one of the most familiar human health barriers worldwide. For our program, the objective is to evaluate the impact of continuous care on the life quality of the COPD patients.

Methods:

This study will be implemented from June 2021 to March 2022 at Shandong Chest Hospital. The experiment was granted through the Research Ethics Committee of Shandong Chest Hospital (0029-4651). The criteria for inclusion involves:

The criteria for exclusion contains:

For our research, the result measure is St. George's Respiratory Questionnaire (SGRQ).

Results:

Table 1 reflects the comparison results of 2 groups after the intervention.

Conclusion:

The continuous care on the basis of the theory of Information, Knowledge, Attitude, and Practice (IKAP) can promote the improvement of life quality in the COPD patients.

Trial registration number: researchregistry 6266.
A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults
Authors: Lee Mee-Ri , Jung Sung Min
Published: January 2021

To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.

In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19–49 years, men and women aged 50–80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).

Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19–49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50–80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.

In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.
Effect of dexmedetomidine on perioperative hemodynamics and organ protection in children with congenital heart disease
Authors: Ming Shaopeng , Xie Yongguo , Du Xueke , Huang Haiqing , Fan Yue , Liang Qingxuan , Xie Yubo
Published: January 2021

Background:

This study aimed to investigate the effects of dexmedetomidine (Dex) on hemodynamics and organ protection in congenital heart disease (CHD) children who underwent open-heart surgery under cryogenic cardiopulmonary bypass.

Methods:

Ninety children were randomly allocated to group C (0.9% saline 0.2 μg/kg/hour), group D1 (Dex 0.2 μg/kg/hour), and group D2 (Dex 0.4 μg/kg/hour) (n = 30 per group). All participants received fentanyl, propofol and 1% sevoflurane for anesthesia induction. Hemodynamic data were measured from T0 (before the induction) to T7 (30 minutes after extubation). The difference of arterial internal jugular vein bulbar oxygen difference and cerebral oxygen extraction ratio were calculated according to Fick formula. Enzyme-linked immunosorbent assay was performed to detect the serum myocardial, brain and kidney injury markers. The incidence of acute kidney injury (AKI) was calculated by serum creatinine level. Tracheal extubation time, postoperative pain score and emergence agitation score were also recorded.

Results:

Compared with group C, group D1, and D2 exhibited reduction in hemodynamic parameters, myocardial and brain injury indicators, and tracheal extubation time. There were no significant differences in blood urea nitrogen and neutrophil gelatinase-associated lipocalin or incidence of AKI among the 3 groups. Besides, the incidence of tachycardia, nausea, vomiting and moderate agitation, and the FLACC scale in group D1 and D2 were lower than those in group C. Moreover, Dex 0.4 g/kg/hour could further reduce the dosage of fentanyl and dopamine compared with Dex 0.2 g/kg/hour.

Conclusions:

Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.
Pulmonary thromboembolism in coronavirus disease 2019 patients undergoing thromboprophylaxis
Authors: Schiaffino Simone , Giacomazzi Francesca , Esseridou Anastassia , Cozzi Andrea , Carriero Serena , Mazzaccaro Daniela P. , Nano Giovanni , Di Leo Giovanni , Spagnolo Pietro , Sardanelli Francesco
Published: January 2021

We aimed to investigate the prevalence of pulmonary thromboembolism (PTE) and its association with clinical variables in a cohort of hospitalized coronavirus disease 2019 (COVID-19) patients receiving low-molecular-weight heparin (LMWH) at prophylactic dosage.

In this retrospective observational study we included COVID-19 patients receiving prophylactic LMWH from admission but still referred for lower-limbs venous Doppler ultrasound (LL-US) and computed tomography pulmonary angiography (CTPA) for clinical PTE suspicion. A dedicated radiologist reviewed CTPA images to assess PTE presence/extension.

From March 1 to April 30, 2020, 45 patients were included (34 men, median age 67 years, interquartile range [IQR] 60–76). Twenty-seven (60%) had PTE signs at CTPA, 17/27 (63%) with bilateral involvement, none with main branch PTE. In 33/45 patients (73%) patients LL-US was performed before CTPA, with 3 patients having superficial vein thrombosis (9%, none with CTPA-confirmed PTE) and 1 patient having deep vein thrombosis (3%, with CTPA-confirmed PTE). Thirty-three patients (73%) had at least one comorbidity, mainly hypertension (23/45, 51%) and cardiovascular disease (15/45, 33%). Before CTPA, 5 patients had high D-dimer (11.21 μg/mL, IQR 9.10–13.02), 19 high fibrinogen (550 mg/dL, IQR 476–590), 26 high interleukin-6 (79 pg/mL, IQR 31–282), and 11 high C-reactive protein (9.60 mg/dL, IQR 6.75–10.65), C-reactive protein being the only laboratory parameter significantly differing between patients with and without PTE (P = .002)

High PTE incidence (60%) in COVID-19 hospitalized patients under prophylactic LMWH could substantiate further tailoring of anticoagulation therapy.
Effect of bilevel continuous positive airway pressure for patients with type II respiratory failure due to acute exacerbation of COPD
Authors: Teng Wenzhe , Chen Hu , Shi Siyao , Wang Yin , Cheng Kangyao
Published: January 2021

Background:

The purpose of this study is to determine the therapeutic efficacy of bi-level continuous positive airway pressure (BIPAP) intervention in patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods:

This review will only include randomized controlled trials (RCTs). The search strategy will be applied to 4 Chinese databases: China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Database (SinoMed); and 5 foreign literature databases: PubMed, Cochrane Library, Springer, EBSCO, and Web of Science. RCTs published from inception to October 2020 will be included. The 2 researchers will independently screen and extract the data and assess quality. The main results obtained through blood gas analysis and equipment observation, heterogeneity assessment, sensitivity analysis, funnel chart synthesis, data synthesis, and grouping analysis will be carried out using Review Manager 5.4 software. The trial sequential analysis will be completed using TSA v0.9 developed by the CTU at the Copenhagen Clinical Trial Center.

Results:

In the current meta-analysis, we will provide more practical and targeted results for the therapeutic efficacy of BIPAP in patients with type II respiratory failure due to acute exacerbation of COPD.

Conclusion:

This study will provide new evidence for the therapeutic efficacy of BIPAP in patients with type II respiratory failure due to acute exacerbation of COPD.

Registration number:

INPLASY2020110003 (DOI:10.37766/inplasy2020.11.0003).
A giant biliary cyst of Todani IA in a young woman
Authors: Mrowiec Sławomir , Jabłońska Beata , Baron Jan , Gajda Magdalena , Stelmach Anna , Zemła Patryk , Liszka Łukasz
Published: January 2021

Rationale:

Biliary cysts (BC) are rare dilatations of various parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. Total cyst excision and Roux-Y hepaticojejunostomy is the treatment method of choice in most patients. In this paper, a novel surgical treatment with the use of internal biliary and pancreatic catheters was presented.

Patient concerns:

A 21-years-old woman with a giant choledochal cyst of Todani IA type presenting with abdominal pain, nausea, fever and palpable abdominal mass. It had been previously drained as a misdiagnosed pancreatic cyst in another hospital.

Diagnosis:

A very high amylase level (107140,0 U/l) in drain fluid was noted in laboratory tests. Endoscopic retrograde cholangiopancreatography revealed a biliary cyst located in the distal common bile duct and a pancreaticobiliary anomaly was suggested. A cholangiography per catheter inserted to the biliary cyst showed a large round contrast-filled cyst. A cholangiography following cyst decompression revealed a very long, tortuous bile duct entering the duodenum.

Interventions:

Cholecystectomy, cyst resection, Roux-Y hepaticojejunostomy, and implantation of catheters into pancreatic and bile duct were performed. The postoperative course was uneventful and she was discharged on 12th day without any complications. Histopathology revealed a cyst wall partially lined with biliary-type and mucinous epithelium, with dysplasia ranging from low to high grade (biliary intraepithelial neoplasia, high grade), without invasion.

Outcomes:

The biliary and pancreatic catheters were removed during endoscopic retrograde cholangiopancreatography 8 weeks following surgery without any complications. Fourteen months later, the patient reported good health.

Lessons:

Diagnosis of the abdominal cyst should be very precise in order to avoid misdiagnosis and inadequate management. The early diagnosis and proper treatment of BC are needed in order to avoid serious complications. The cholangiocarcinoma is the most dangerous potential complication of BC due to dysplasia within the cyst wall as in our young female patient.
The effectiveness of acupoint herbal patching for functional constipation
Authors: Yan Bing , Jiang Hailin , Cao Jiazhen , Liu Yanze , Liu Xiaona , Ha Lijuan , Li Tie , Wang Fuchun , Liu Chengyu
Published: January 2021

Background:

Functional constipation is a common functional problem of the digestive system that has a negative impact on physical, mental health of patients and quality of life. At present, acupoint herbal patching as an adjuvant therapy is currently undergoing clinical trials in different medical centers. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of acupoint herbal patching on functional constipation. There is also a lack of systematic evaluation and analysis of acupoints and herbs.

Methods:

We will search the following 8 databases from their inception to November 15, 2020, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database and the China National Knowledge Infrastructure. The primary outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the GRADE approach to assess the overall quality of evidence supporting the primary outcomes. We will also use Spass software (Version19.0) for complex network analysis to explore the potential core prescription of acupoint herbal patching for functional constipation.

Results:

This study will analyze the clinical effective rate, functional outcomes, quality of life, improvement of clinical symptoms of functional constipation, and effective prescriptions of acupoint herbal patching for patients with functional constipation.

Conclusion:

Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint herbal patching for patients with functional constipation.

PROSPERO registration number:

PROSPERO CRD 42020193489.
KCNQ1 G219E and TRPM4 T160M polymorphisms are involved in the pathogenesis of long QT syndrome
Authors: Zhao Yang , Feng Min , Shang Lu-Xiang , Sun Hua-xin , Zhou Xian-Hui , Lu Yan-Mei , Zhang Ling , Xing Qiang , Li Yao-dong , Tang Bao-Peng
Published: January 2021

Rationale:

Long QT syndrome (LQTS) is an inheritable disease characterized by prolonged QT interval on the electrocardiogram. The pathogenesis of LQTS is related to mutations in LQTS-susceptible genes encoding cardiac ion channel proteins or subunits.

Patient concerns:

Here, we reported a 37-year-old female Uygur patient with palpitation and loss of consciousness.

Diagnoses:

At the time of admission, a 12-lead electrocardiogram showed a QTc interval of 514 ms. Genetic analysis revealed KCNQ1 G219E and TRPM4 T160M mutations.

Interventions:

Although beta-blockers remain the mainstay in treating LQTS, the patient underwent implantation of an automatic cardioverter defibrillator due to life-threatening arrhythmias.

Outcomes:

To explore the effect of the calcium ion antagonist verapamil on ion channels, we generated human induced pluripotent stem cell cardiomyocytes (hiPSC-CMs) from the peripheral blood mononuclear cells of the patient. The changes of action potential duration in response to verapamil were observed.

Lessons:

Our results showed that patient-derived hiPSC-CMs could recapitulate the electrophysiological features of LQTS and display pharmaceutical responses to verapamil.
Contrast-enhanced ultrasound diagnosis of prostatic sarcoma
Authors: Wu Guozhu , Sun Ran , Hong Hua , Wang Yumin , Li Jing , Liu Qian , Sun Aitong
Published: January 2021

Rationale:

Prostatic sarcoma (PS) is a very rare malignant tumor that accounts for <0.1% of prostate malignancies, and Ewing's sarcoma is an extremely rare form of PS.

Patient concerns:

We reported on a 64-year-old patient with PS and a 36-year-old patient with Ewing's sarcoma, both of whom were examined by contrast-enhanced ultrasonography (CEUS) before surgery.

Diagnoses:

The 2 cases were proven to be prostatic stromal sarcoma, which was confirmed by imaging manifestations and histopathological findings.

Interventions:

The 64-year-old patient underwent radical prostatectomy, and the 36-year-old patient underwent chemotherapy combined with local radiotherapy.

Outcomes:

PS showed diffuse enlargement of the prostate on sonography, and the necrotic liquefying area within the large vessels could be clearly displayed by CEUS. CEUS can be advocated as a valuable noninvasive and safe imaging diagnosis method for PS.
Ectopic thyroid gland located on the L4 vertebral body
Authors: Lin Qihuan , Gao Qilu , Fan Rong , Zhang Li , Li Weijia , Liu Hongkun , Zheng Wenbin
Published: January 2021

Rationale:

The prevalence of ectopic thyroid is extremely low, with the condition observed in approximately 1 in 100,000 to 300,000 people. Thyroid gland ectopia develops as a result of the presence of developmental abnormalities during the migration of the thyroid anlage from the floor of the primitive foregut to its final position in the neck. Ectopic thyroid tissue is commonly observed in the lingual region, but can also present in other head and neck regions, as well as regions located at a large distance from the neck.

Patient concerns:

A 67-year-old woman who had experienced left lumbago and leg pain was transferred to our hospital following the worsening of her lumbago-related symptoms in the 2 months preceding her presentation. Seven years ago, the patient had recurrent lumbago and leg pain without obvious inducement, and visited a local clinic for treatment. The severity of her symptoms fluctuated; their intensity increased after participation in activities and decreased after rest.

Diagnoses:

The patient was diagnosed as having an ectopic thyroid gland that was located on the L4 vertebral body.

Interventions:

The patient chose to undergo surgery, with supportive care, following tumor discovery.

Outcomes:

After surgical treatment, the degree of lumbar spinal stenosis improved, and the patient's clinical symptoms were alleviated.

Lessons:

Clinically, ectopic goiter is diagnosed through radionuclide thyroid imaging, ultrasound examination, computed tomography, magnetic resonance imaging, and biopsy pathology. However, the imaging manifestations in this case were atypical, leading to greater diagnostic difficulties. A conclusion was finally reached based on pathology.
Herb-induced autoimmune-like hepatitis associated with Xiang-tian-guo (Swietenia macrophylla seeds)
Authors: Shao Yue-Ming , Zhang Yu , Yin Xin , Qin Ting-Ting , Jin Qing-Long , Wen Xiao-Yu
Published: January 2021

Rationale:

Drug-induced liver injury (DILI) has a relatively low incidence, whereas the incidence of herb-induced liver injury (HILI) is still under investigation. As a special type of DILI, the diagnosis of drug-induced autoimmune-like hepatitis presents a persistent challenge, because this condition has partial characteristics of both DILI and autoimmune hepatitis (AIH), such as a certain history of medication use and histology that similar is to AIH. Thus, the differential diagnosis between DILI and AIH can be confusing.

Patient concerns:

A 67-year-old woman taking xiang-tian-guo for 6 months was admitted to our hospital with a complaint of experiencing jaundice for 2 weeks.

Diagnosis:

A liver biopsy exhibited interface inflammation, foam cells, and “rosette” -like hepatocytes. She was diagnosed with herb-induced liver injury (hepatocellular and acute), a RUCAM score of 7 (probable), a severity for grade 4 liver injury, and accompanied autoimmune-like changes.

Interventions:

The patient was instructed to cease the administration of suspicious drugs. The patient also received liver protection and albumin transfusion.

Outcomes:

After 25 days of hospitalization, the patients aminotransferase levels returned to normal. No recurrence was observed after the administration of the treatments and a close follow-up.

Lessons:

We must to be vigilant about the safety of xiang-tian-guo as a herbal medicine. When faced with the difficulty of distinguishing between AIH and DILI, long-term follow-up observations for recurrence can aid clinicians in making a judgment.
Application of contrast-enhanced ultrasound in the diagnosis of post-transplant lymphoproliferative disease after hematopoietic stem cell transplantation
Authors: Chen Weinan , Li Jianchun , Fan Xiaoming , Zhang Yanming , Wang Li , Liu Yang , Cui Ailin , Wang Ligang
Published: January 2021

Introduction:

Post-transplant lymphoproliferative disease (PTLD) is a series of proliferative diseases of the lymphatic system. Among patients receiving hematopoietic stem cell transplantation (HSCT), PTLD is a prevalent complication that severely affects rates of survival. Ultrasound plays an essential role in the early diagnosis of PTLD. Contrast-enhanced ultrasonography (CEUS) and CEUS-guided biopsy are critical procedures for tumor diagnosis.

Patient concerns:

Herein, we report the case of a 40-year-old male patient with acute lymphoblastic leukemia who received HSCT more than 1 year ago. Sonography revealed a small hypoechoic nodule in the liver four months after HSCT. Eight months after HSCT, larger and more nodules were observed via ultrasound; CT was used to identify the lesions.

Diagnoses:

CEUS and CEUS-guided biopsy were performed, and the pathological diagnosis was PTLD.

Interventions:

The final clinical diagnosis was PTLD, and cyclophosphamide, epirubicin, and dexamethasone were administered as chemotherapy.

Outcomes:

The patient was discharged after his condition improved.

Conclusion:

Ultrasound can be used to effectively detect lesions of PTLD early after HSCT. Furthermore, CEUS and CEUS-guided biopsy were effective for early confirmatory diagnoses of PTLD after HSCT.
The safety and efficacy of astragalus for treating diabetic foot ulcers
Authors: Liu Donghao , Zhong Yanmei , Yan Hang , Hu Yuanzhang , Chen Yuzhu , Zhou Yi
Published: January 2021

Background:

Diabetic foot ulcers are the most common complication among diabetic patients, which may put the patients in a great danger of amputation. Astragalus as a Chinese herbal medicine has been reported in many publications that it has an efficacy toward diabetic foot ulcers. However, the systematic review and meta-analysis of its efficacy and safety are still absent. Therefore, we aim to evaluate the effectiveness and safety of Astragalus for diabetic foot ulcers.

Methods:

The following databases will be searched from January 1st, 2010 to September 2020: The Cochrane Library, Pubmed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. All the English and Chinese publications will be searched without any restriction of countries. Data will be extracted by 2 reviewers independently. RevMan 5.4.1. will be used to perform analysis and synthesis of data.

Results:

This meta-analysis of randomized controlled trials will evaluate the efficacy and safety of Astragalus for diabetic foot ulcers during the past 10 years.

Conclusion:

This study will provide an evidence to judge whether Astragalus is effective and safe for diabetic patients with foot ulcers.

INPLASY registration number:

Inplasy protocol 2020110059. (doi:10.37766/inplasy2020.11.00596).
Application of the transoral endoscopic vestibular approach for a benign upper neck mass
Authors: Lee Dong Won , Kim Jeong Kyu , Tae Kyung
Published: January 2021

Rationale:

Excision of a benign neck mass is traditionally performed via the transcervical approach. In order to avoid visible scars in the neck, various remote access surgical approaches have been developed. The aim of this report is to present the technique of a transoral endoscopic vestibular approach for treatment of a benign upper neck mass.

Patient concerns:

A 47-year-old female with an anterior upper neck mass and throat discomfort visited our institution.

Diagnosis:

The computed tomography (CT) scans and ultrasound (US) images demonstrated a benign-appearing mass on the anterior upper neck area.

Interventions:

The benign upper neck mass was successfully removed via the transoral endoscopic vestibular approach, without any complication.

Outcomes:

The final pathologic report indicated that the lesion was an epidermal cyst. The cosmetic result was excellent.

Lessons:

From this case study, we can learn to apply a transoral endoscopic vestibular approach for removal of a benign upper neck mass. Based on the outcomes, endoscopic removal of the benign upper neck mass via a transoral vestibular approach can be useful for patients who wish to hide any anterior neck scar.