bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease
Authors: Guo Binbin , Yang Tian , Nan Jinniang , Huang Qianghui , Wang Chenxiu , Xu Wenpeng
Published: February 2021

Background:

Coronary heart disease is a serious cardiovascular disease. There is coronary atherosclerosis, resulting in lumen stenosis, blockage, and then the symptoms of insufficient blood supply and hypoxia in the myocardium. Chronic heart failure is a kind of syndrome with abnormal ventricular filling and ejection function, which is the final stage of the development of coronary heart disease. At present, the treatment plan of Western medicine can significantly reduce the hospitalization rate, but it is still not satisfactory for the prognosis and mortality of patients. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical studies to verify it, so the purpose of this randomized controlled study is to evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease.

Methods:

This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The patients will be randomly divided into a treatment group and the control group according to 1:1, in which the treatment group is treated with Shenfu injection combined with sodium nitroprusside, and the control group is treated with sodium nitroprusside alone. Both groups will be treated with standard treatment for 7 days and followed up for 30 days to pay attention to their efficacy and safety indexes. The observation indexes include TCM syndrome score, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, brain natriuretic peptide, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, stroke volume, adverse reactions and so on. We will use SPSS 25.0 software for data analysis.

Discussion:

This study will evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The results of this experiment will provide a clinical basis for Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in coronary heart disease.

Trial registration:

DOI 10.17605/OSF.IO/4KNG3
Nanoparticle albumin-bound paclitaxel versus solvent-based paclitaxel in breast cancer
Authors: Li Bingxue , Chen Xinjie , Ding Tongjing , Liu Yihua , Ma Tingting , Zhang Ganlin , Wang Xiaomin
Published: February 2021

Background:

Nanoparticle albumin-bound paclitaxel (nab-PTX) has exhibited clinical efficacy in breast cancer treatment, but toxicities can be yielded more at the same time. We did this meta-analysis aiming to unambiguously compare nab-PTX with conventional solvent-based paclitaxel in breast cancer patients of all stages.

Method:

Pubmed, EMBASE, Cochrane Library, Chinese Biomedical database, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical database, and WangFang database were searched for head-to-head randomized controlled trials of nab-PTX and solvent-based paclitaxel in breast cancer. Other sources will also be searched like Google Scholar and gray literatures. Two researchers will independently search the database and extract data from the articles. Risk of bias will be assessed using the Cochrane Collaboration's tool. Objective tumor response rate, chemotherapy completion rate after 4 or 6 cycles, and toxicity will be primary outcomes. Disease control rate, overall survival, and progression-free survival/disease-free survival will be included in secondary outcomes. Risk ratio with 95% confidence interval was used for dichotomous variables while hazard ratio was used for time-to-event outcomes. The following 3 data sets will all be considered when synthesizing the data: intention-to-treat population, those who actually received taxanes treatment, and those who were actually assessed. All the analyses were done using Review Manager Software 5.3. Any disagreements in study selection, data collection, and analysis will be resolved by a third investigator.

Results and conclusion:

This study is aim to evaluate the efficacy and safety of nab-PTX compared with PTX in breast cancer treatment as well as to find the best dose or schedule and identify the benefit population. This meta-analysis could provide evidence for clinicians to make a better choice between nab-PTX and PTX in different specific contexts.

Prospero registration number:

CRD42019117912.
Related factors for depression among Chinese men who have sex with men
Authors: Zheng Yuping , Gao Jing , Jiang Xiaolin
Published: February 2021

Background:

Men who have sex with men (MSM) are the focus group of acquired immune deficiency syndrome intervention, because of the impact of social concepts, they suffer from a lot of social discrimination, and mental health problems are more prominent. Depression is prevalent in Chinese MSM. The aim of this systematic review is to systematically assess the current evidence on factors associated with depression among Chinese MSM.

Methods:

This study will be conducted in strict accordance with the preferred reporting items for systematic reviews and meta-analysis protocols. China National Knowledge Infrastructure, VIP Database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and the Cochrane Library will be searched comprehensively to collect cross-sectional studies, case-control studies, Cohort studies for depression of the related factors among Chinese MSM. The retrieval time is limited from the establishment of the database to December 2020. Two researchers independently evaluate the study and extract the data according to the inclusion and exclusion criteria. Meanwhile, the Newcastle–Ottawa scale and the bias risk assessment criteria of the agency for healthcare research and quality will be used to evaluate the risk of bias in the included studies, and the meta-analysis will be carried out by using Stata 15.0.

Results:

This study will systematically evaluate the related factors for depression among Chinese MSM based on published studies. The results will be presented here.

Conclusion:

The conclusion of the systematic review and meta-analysis will provide clinical evidence for the related factors and prevention and treatment measures of depression among Chinese MSM.
Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications
Authors: Song Tingting , Liu Xiancun , Han Rui , Huang Lihua , Zhang Jingjing , Xu Haiyang
Published: February 2021

A history of transient ischemic attack, severity of disease, urinary output, hematocrit, hypocapnia, and hypotension during direct revascularization (superficial temporal artery to middle cerebral artery [STA-MCA]) in patients with Moyamoya disease (MMD) may lead to a poor prognosis, however, to our knowledge evidence for end-tidal carbon dioxide (ETCO2) targets is lacking. Within the ranges of standardized treatment, the article was primarily designed to study the risk factors associated with the neurologic outcomes during STA-MCA for MMD especially including ETCO2 ranges and the duration in different groups. The primary goals of this study were to investigate the risk factors for neurologic deterioration and explore the association between ETCO2 ranges and neurologic outcome during general anesthesia for STA-MCA.

This retrospective observational study included 56 consecutively adult Moyamoya patients who underwent STA-MCA under general anesthesia between January 2015 and August 2019. ETCO2 was summarized per patient every 5 minutes. Clinical outcome was assessed with clinical presentation, computed tomography findings, magnetic resonance imaging findings, cerebral angiography, and the modified Rankin Scale scores at discharge as main outcome measure. The outcomes were also compared for the duration of surgery, anesthesia, and the length of stay.

A total of 56 patients were studied, all patients had comprehensive ETCO2 measurements. The incidence of postoperative complications was 44.6% (25/56). There was no association between age, sex, hypertension, diabetes, smoking history, drinking history, sevoflurane use, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis and postoperative complications. Duration of surgery (P = .04), anesthesia (P = .036), hospital stay (P = .023) were significant correlates of postoperative complications. In the multiple logistic regression model, they were not the significant predictors. The ETCO2 ranges and the length of time in different groups within the current clinical setting was not associated with postoperative complications (P > .05).

Within a standardized intraoperative treatment strategy, we found that postoperative complications had no significant correlation with sex, age, hypertension, diabetes, smoking history, drinking history, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis, or sevoflurane use. Further, hypocapnia and hypercapnia during STA-MCA were not found to be associated with postoperative complications in patients with MMD.
Three-dimensional finite element analysis of temporomandibular joints in patients with jaw deformity during unilateral molar clenching before and after orthognathic surgery
Authors: Teng Haidong , Shu Jingheng , Wang Quanyi , Shao Bingmei , Zheng Tinghui , Liu Zhan
Published: February 2021

To analyze the effects of orthognathic surgery on stress distributions in the temporomandibular joint (TMJ) of patients with jaw deformity during unilateral molar clenching (UMC) by using three-dimensional (3D) finite element method.

Nine patients with jaw deformity (preoperative group, 26.1 ± 5.6 years old) and 9 asymptomatic subjects (control group, 22.0 ± 6.0 years old) were selected. Furthermore, the patients with jaw deformity were also considered as the postoperative group after undergoing orthognathic surgery. Finite element models for the mandible, articular disc, and maxilla were developed through cone beam computed tomography. Contact was used to simulate the interaction of the articular disc, condyle, fossa, and upper and lower dentition. The muscle forces and boundary conditions corresponding to the UMC were applied on the models.

The stresses on both TMJs of the control group were significantly different, whereas there was no significant difference on both sides for the preoperative group. All the stresses of the preoperative group were greater than those of the control and postoperative groups, except the minimum principal stress on the ipsilateral fossa.

Orthognathic surgery is beneficial for alleviating the abnormal stress distributions on TMJ.
Methotrexate can prevent cardiovascular events in patients with rheumatoid arthritis
Authors: Sun Kai-jun , Liu Lei-ling , Hu Jia-hui , Chen Yan-ying , Xu Dan-yan
Published: February 2021

Aims:

The incidence of cardiovascular events (CVEs) in patients with rheumatoid arthritis (RA) is higher than that in people without RA. This may be because inflammation promotes the progression of atherosclerosis. Anti-inflammatory drugs might reduce the occurrence of CVEs in patients with RA. Methotrexate (MTX) is a conventional synthetic anti-rheumatic drug that is widely used in the treatment of RA. We performed a meta-analysis to determine whether MTX can prevent CVEs in RA patients. Then, we discussed the possibility of using MTX to prevent recurred CVEs in patients with coronary heart disease (CHD).

Methods:

We searched PubMed, Embase, Web of Science, and the Cochrane Library using the key words “methotrexate,” “cardiovascular,” “acute coronary syndrome,” “coronary heart disease,” “myocardial infarction,” “angina pectoris,” and “rheumatoid arthritis.” The efficacy outcome was defined as a composite of CVEs, including stable angina, acute coronary syndrome, stroke, heart failure, and cardiac death.

Results:

A total of 10 studies and 195,416 RA patients were included in our meta-analysis, and the effect size of relative risk (RR) was pooled using a fixed effect model. The results showed that MTX prevented CVEs in RA patients (RR: 0.798, 95% CI 0.726–0.876, P = .001, I
2 = 27. 9%).

Conclusion:

MTX can prevent CVEs in RA patients, but there is not sufficient evidence for using MTX to treat patients with CHD.
Clinical characteristics and prognosis of elderly patients with colorectal cancer
Authors: Kim Soohwan , Kim Dong Suk , Soh Jae Seung , Lim Sang-Woo , Lim Hyun , Kang Ho Suk , Kim Jong Hyeok
Published: February 2021

Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.

A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.

The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.

Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.
Ureteral calculi associated with high-altitude polycythemia
Authors: Yang Min , Cui Sen , Wuren Tanna , Ma Kexiong , Ge Ri-Li , Ji Linhua
Published: February 2021

Rationale:

High-altitude polycythemia (HAPC) is a common disease in high-altitude areas characterized by excessive erythrocyte proliferation and severe hypoxemia. Recently, the incidence of ureteral calculi has risen. However, cases of ureteral calculi associated with HAPC have not been reported.

Patient concerns:

We present the cases of 2 patients (26-year-old female, Case 1; 31-year-old male, Case 2) with HAPC who were born in the lowlands and worked in areas of high altitudes. Both patients were admitted to the hospital with acute severe pain in the ureter as the first symptom.

Diagnoses:

Urological examinations confirmed the presence of a ureteral stone. Interestingly, the biochemical tests showed elevated serum uric acid levels, and the calculous component analysis suggested anhydrous uric acid.

Interventions:

In the first case, the patient underwent extracorporeal shock wave lithotripsy. In the second case, the patient underwent right ureteroscopy and right ureteral stenting. The patient received postoperative anti-inflammatory, hemostatic, and rehydration therapy.

Outcomes:

Both patients recovered well with no recurrences observed upon regular re-examinations.

Lessons:

Recently, extensive research has demonstrated a significant correlation between hyperuricemia and HAPC. Therefore, we speculated that the occurrence of ureteral calculi among immigrants to the plateau might be related to hyperuricemia associated with HAPC. This case report and literature review highlights that the prevention of ureteral calculi in patients with polycythemia who immigrate to the plateaus from high-altitude areas should be considered. Additionally, the serum uric acid levels and urine pH should be monitored regularly.
Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery
Authors: Zhao Yibo , Xi Chunyang , Xu Wenxiao , Yan Jinglong
Published: February 2021

Background:

This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery.

Methods:

In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test.

Results:

Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: –215.655, 95%CI: (–307.462, –123.847), P < .001], postoperative [WMD: –69.213, 95%CI: (–104.443, –33.983), P = .001] and total [WMD: –284.388, 95%CI: (–437.66, –131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: –333.775, 95%CI: (–540.45, –127.099), P = .002] and postoperative [WMD: –114.661, 95%CI: (–219.58, –9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048].

Conclusion:

The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.
Severe chemosis and treatment following fronto-orbital advancement surgery for Crouzon syndrome
Authors: Wu Shui-Hua , Liu Tian-Jia , Fan Shuang-Shi , Chen Zhao-Hui , Wang Xi-Lang , Gu Shuo
Published: February 2021

Rationale:

Crouzon syndrome is a craniofacial malformation caused by premature fusion of fibrous sutures in infants. It is one of the most common craniosynostosis syndromes, and surgery is the only effective treatment for correcting it. Postoperative complications such as encephalocele, infections, hematoma have been reported. We herein report a case of a 62-month-old boy with Crouzon syndrome who underwent fronto-orbital advancing osteotomy, cranial vault remolding, and extensive osteotomy and subsequently developed left proptosis and severe chemosis, these complications are rare and we believe it will be of use to clinicians, physicians, and researchers alike.

Patient concerns:

The patient's skull had been malformed since birth, and he had been experiencing paroxysmal headaches coupled with vomiting for 4 months. Having never received prior treatment, he underwent fronto-orbital advancement at our clinic; afterward, left proptosis and severe chemosis occurred.

Diagnosis:

The patient was diagnosed with Crouzon syndrome, and the complications included left proptosis and severe chemosis, confirmed by the clinical manifestations, physical examination, and computed tomography (CT).

Intervention:

We carried out cranial vault remodeling and fronto-orbital advancement. We applied ophthalmic chlortetracycline ointment on the conjunctivae, elevated the patient's head, evacuated the hematoma, and carried out a left blepharorrhaphy.

Outcomes:

The proptosis and chemosis resolved with no recurrence. No other complications occurred during the follow-up period (12 months), and CT scans revealed that the hematoma had disappeared. The calvarial vault reshaping was satisfactorily performed, and the patient's vision was not impaired.

Lessons:

Severe proptosis and chemosis are rare complications that can occur after fronto-orbital advancement for Crouzon syndrome. A detailed preoperative examination (including magnetic resonance imaging and CT) is essential for diagnosis. Complete hemostasis, evacuation of hematoma, and placement of a periorbital drainage tube during surgery all contribute to an effective treatment plan. An ophthalmic ointment should be administered, and the patient's head should be elevated during the procedure. Evacuation of retrobulbar epidural hematoma and blepharorrhaphy could also help relieve proptosis and chemosis. Our report describes 2 rare complications associated with the treatment for Crouzon syndrome, and we believe it will be of use to clinicians, physicians, and researchers alike.
Ketorolac plus Lidocaine vs Lidocaine for pain relief following core needle soft tissue biopsy
Authors: Chobpenthai Thanapon , Ingviya Thammasin , Thanindratarn Pichaya , Jaiwithee Rattakorn , Sutthivaiyakit Kulwadee
Published: February 2021

Backgrounds:

The main objective of this study was to compare the pain control efficacy of local administration of Lidocaine with or without the nonsteroidal anti-inflammatory drug, Ketorolac, and local conventional Lidocaine injection in core needle biopsy of the musculoskeletal tumor.

Methods:

The current study was a randomized, double-blind controlled clinical trial that included 128 patients with suspected musculoskeletal tumors. Patients were randomly assigned to either the Ketorolac plus Lidocaine (n = 64) or Lidocaine group (n = 64). The Ketorolac – Lidocaine combination syringe contained 30 mg Ketorolac and 2% Lidocaine – adrenaline dosage, and the Lidocaine syringe contained 2% Lidocaine – adrenaline dosage. The level of pain after core needle biopsy was evaluated for each patient at 1, 6, 12, 24, 48, and >48 hours by a Visual Analog Scale (VAS). The mean VAS changes over time were compared between the Ketorolac plus Lidocaine and Lidocaine groups using a linear mixed model.

Results:

baseline information including mean age of patients in Lidocaine group (51.5 ± 19.4 years) and in Lidocaine – Ketorolac combination group (50.1 ± 18 years), diagnosis (malignant, benign, metastatic, infection), tumor location (upper and lower extremities, back), VAS score 1-hour post-operation (mild and moderate pain) were noted. The VAS score ratings were significantly lower in Lidocaine – Ketorolac combination group when compared to the Lidocaine group during the 1 to 24 hours post-operation time period.

Conclusion:

Patients receiving Lidocaine – Ketorolac combination dosage had significantly lower VAS scores, and these results confirm that local injection of Lidocaine – Ketorolac combination had a superior pain-controlling effect during the first 24 hours after the biopsy procedure in comparison to Lidocaine injection alone, as measured by VAS score scale.
Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients
Authors: Juliao-Baños Fabian , Kock Joshua , Arrubla Mateo , Calixto Omar , Camargo Joselyn , Cruz Lina , Hurtado Juan , Clavijo Absalon , Donado Jorge , Schwartz Seth , Abreu Maria T. , Damas Oriana M.
Published: February 2021

The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.

We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010–2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.

The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09–1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92–0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02–1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19–4.69 P < .001).

Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.
Prediction of age and sex from paranasal sinus images using a deep learning network
Authors: Kim Dong-Kyu , Cho Bum-Joo , Lee Myung-Je , Kim Ju Han
Published: February 2021

This study was conducted to develop a convolutional neural network (CNN)-based model to predict the sex and age of patients by identifying unique unknown features from paranasal sinus (PNS) X-ray images.

We employed a retrospective study design and used anonymized patient imaging data. Two CNN models, adopting ResNet-152 and DenseNet-169 architectures, were trained to predict sex and age groups (20–39, 40–59, 60+ years). The area under the curve (AUC), algorithm accuracy, sensitivity, and specificity were assessed. Class-activation map (CAM) was used to detect deterministic areas. A total of 4160 PNS X-ray images were collected from 4160 patients. The PNS X-ray images of patients aged ≥20 years were retrieved from the picture archiving and communication database system of our institution. The classification performances in predicting the sex (male vs female) and 3 age groups (20–39, 40–59, 60+ years) for each established CNN model were evaluated.

For sex prediction, ResNet-152 performed slightly better (accuracy = 98.0%, sensitivity = 96.9%, specificity = 98.7%, and AUC = 0.939) than DenseNet-169. CAM indicated that maxillary sinuses (males) and ethmoid sinuses (females) were major factors in identifying sex. Meanwhile, for age prediction, the DenseNet-169 model was slightly more accurate in predicting age groups (77.6 ± 1.5% vs 76.3 ± 1.1%). CAM suggested that the maxillary sinus and the periodontal area were primary factors in identifying age groups.

Our deep learning model could predict sex and age based on PNS X-ray images. Therefore, it can assist in reducing the risk of patient misidentification in clinics.
A nomogram predicting subclinical extension of cutaneous squamous cell carcinoma in Chinese individuals
Authors: Lin Pingping , Zhu Sainan , Zhang Guohong , Huang Yuanshen , Tu Ping , Yang Shuxia , Li Hang
Published: February 2021

Cutaneous squamous cell carcinoma usually extends beyond the visible margin. Little is known about the predictors for cutaneous squamous cell carcinoma with subclinical extension in Chinese individuals. This study aimed to construct a nomogram for predicting the probability of subclinical extension of cutaneous squamous cell carcinoma in Chinese patients.

A retrospective analysis was conducted using data from Mohs micrographic surgery-treated cutaneous squamous cell carcinoma patients at a single institution between December 1, 2009 and October 31, 2019. Subclinical extension was defined as a lesion requiring ≥ 2 Mohs stages or with final safe margins of ≥ 5 mm. A nomogram predicting the probability of subclinical extension was constructed using the predictors identified in multivariable analysis.

Of 274 patients included, 119 (43.4%) had subclinical extension. In multivariable analysis, male sex (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.40–4.29; P = .002), lesions on mucocutaneous areas (OR, 3.71; 95% CI, 1.34–10.32; P = .012) and extremities (OR, 2.40; 95% CI, 1.20–4.78; P = .013), maximum diameter of 10 to 19 mm (OR, 14.15; 95% CI, 4.24–47.28; P < .001), and 20 to 29 mm (OR, 9.21; 95% CI, 2.80–30.29; P < .001) were associated with subclinical extension. A nomogram incorporating these 3 variables demonstrated promising predictive ability (C statistics = 0.78; 95% CI, 0.67–0.89).

The nomogram incorporating sex, tumor location, and maximum diameter can provide individualized prediction for subclinical extension in Chinese patients with cutaneous squamous cell carcinoma. This information may help surgeons determine appropriate margins at the first Mohs stage.
Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension
Authors: Meine Timo C. , Maschke Sabine K. , Kirstein Martha M. , Jaeckel Elmar , Lena Becker S. , Werncke Thomas , Dewald Cornelia L.A. , Wacker Frank K. , Meyer Bernhard C. , Hinrichs Jan B.
Published: February 2021

To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design.

Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography series were post-processed. A reference region-of-interest (ROI) was placed in the afferent splenic artery and a target ROI was positioned on the embolization territory of the spleen on digital subtraction angiography series pre- and post-embolization. The ratios of the target ROIs to the reference ROIs were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using Wilcoxon signed-rank test and Spearman's rank correlation coefficient (r). Afterwards, the study population was divided by the median of the TTP before PSE to analyze its value for the prediction of PR following PSE.

Following PSE, PLT increased significantly from 43,000 ± 21,405 platelets/μL to 128,500 ± 66,083 platelets/μL with a PR of 255 ± 243% (P = .003). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIRpre-PSE 1.23 ± 2.42/WIRpost-PSE 0.09 ± 0.07; -64 ± 46% (p = 0.04), TTPpre-PSE 4.41 ± 0.99/TTPpost-PSE 5.67 ± 1.52 (P = .041); +34 ± 47% and AUCpost-PSE 0.81 ± 0.85/AUCpost-PSE 0.14 ± 0.08; -71 ± 18% (P = .002). A significant correlation of a 2D-PPBF parameter with the PLT was found for TTPpre-PSE/PLTpre-PSE r = -0.66 (P = .01). Subgroup analysis showed a significantly increased PR for the group with TTPpre-PSE >4.44 compared to the group with TTPpre-PSE ≤4.44 (404 ± 267% versus 107 ± 76%; P = .04).

2D-PPBF is an objective approach to analyze the perfusion reduction of embolized splenic tissue. TTP derived from 2D-PPBF has the potential to predict the extent of PR during PSE.
A rare case of primary sinonasal tuberculosis presented with phlyctenular keratoconjunctivitis in a pediatric patient
Authors: Wiriyachai Thakoon , Boonsathorn Sophida , Apiwattanakul Nopporn , Assawawiroonhakarn Surapat
Published: February 2021

Rationale:

Tuberculosis is a common cause of phlyctenular keratoconjunctivitis, especially for patients who live in a high endemic area of tuberculosis. We report a rare case of pediatric phlyctenular keratoconjunctivitis associated with primary sinonasal tuberculosis.

Patient concerns:

A 7-year-old boy presented with a 5-month history of redness of the left eye accompanied by mild visual impairment. Physical examination revealed elevated pinkish-white nodules with a circumcorneal hypervascularized lesion on the left conjunctiva.

Diagnosis:

Computed tomography revealed an enhancing soft tissue mass in the left maxillary sinus with bone destruction. Histopathology of maxillary tissue showed chronic inflammation without granuloma. Special stain, culture and polymerase chain reaction for mycobacterium were initially negative. Left maxillary sinus tuberculosis was diagnosed by positive Mycobacterium tuberculosis polymerase chain reaction from formalin-fixed paraffin-embedded maxillary tissue.

Interventions:

Two month of oral isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by 10 months of oral isoniazid and rifampicin without topical eye drops agent were prescribed.

Outcomes:

Two months after initiation of treatment, the phlyctenular lesion had significantly improved. A follow-up computed tomography showed a significant reduction in the size of the maxillary sinus lesion and the extent of adjacent bone destruction.

Lessons:

Primary sinonasal tuberculosis is an uncommon cause of phlyctenular keratoconjunctivitis in children. When microbiological and histopathological evidences are absent, polymerase chain reaction analysis has a crucial role in the diagnosis of tuberculosis, especially in patient with uncommon presentation.
Metachronous primary cancer of the tongue and malignant lymphoma of the small intestine
Authors: Sugimoto Keisuke , Uejima Shinji , Uchiyama Yumiko , Yasue Reita , Nambu Kazuya , Ishikawa Jun , Koma Yoshiro , Akita Takako , Toh Taketomo , Fujimoto Takehiro
Published: February 2021

Rationale:

Oral cancer often causes secondary primary cancers in the upper gastrointestinal tract. However, there are no reports of secondary primary cancers in patients with oral squamous cell carcinoma and malignant lymphoma of the small intestine. This report describes a case of metachronous multiple primary cancers of the tongue and small intestine malignant lymphoma.

Patients concerns:

The patient was admitted to our department with the chief complaint of pain in the right tongue. Partial tongue resection and supraomohyoid neck dissection were performed. One year after surgery, the patient experienced abdominal pain and bloody stools.

Diagnosis:

Diffuse large B-cell lymphoma (DLBCL) was diagnosed via histological examination.

Interventions:

A terminal ileum resection was performed. Postoperatively, the patient received 6 courses of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP).

Outcomes:

Five years after his initial diagnosis, there is no evidence of recurrence, metastasis, or other primary cancer.

Lessons:

Oral cancer patients should always be followed up owing to a possibility of malignant tumors in other areas.
Efficiency of free thyroxine in predicting severity and mortality of patients with acute pancreatitis
Authors: Cheng Tao , Xiao Bo-Jie , Liu Bo-Fu , Han Tian-Yong , Yu Hai-Fang
Published: February 2021

Background:

Previous studies suggest that free thyroxine may be used as a severity indicator of patients with acute pancreatitis (AP) in emergency department, helping determine the differential care of AP. However, there are no systematic reviews and the association between free thyroxine and AP is still not completely understood. Therefore, we will undertake a systematic review of the literature to summarize previous evidence regarding this topic, in order to clarify whether free thyroxine can help us pick out the mild AP cases.

Methods

: We will search the EMBASE, Web of Knowledge, PubMed, ClinicalTrials.gov, and Cochrane Library from inception to Mar 2021 to retrieve relevant studies using the search strategy: (“free thyroxine”) AND (pancreatitis OR pancreatitides). Two authors independently judged study eligibility and extracted data. Heterogeneity will be examined by computing the Q statistic and I

2
statistic.

Results

: This study proved the efficiency of free thyroxine in predicting the severity of patients with AP.

Conclusions

: This study will provide reliable evidence-based evidence for the clinical application of free thyroxine predicting the severity of patients with AP.

Ethics and dissemination:

Ethical approval is unnecessary as this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference.
Features of the gut microbiota in ulcerative colitis patients with depression
Authors: Chen De-Liang , Dai Yan-Cheng , Zheng Lie , Chen You-Lan , Zhang Ya-Li , Tang Zhi-Peng
Published: February 2021

Despite the establishment of the links between ulcerative colitis (UC) and depression, between UC and gut microbiota, few correlations between depression and gut microbiota have yet been demonstrated especially in ulcerative colitis patients. The objective of our study was therefore to determine whether the comorbidity of depressive disorder in ulcerative colitis patients correlate with alterations in the gut microbiota and to identify the specific microbiota signatures associated with depression.

Between March 2017 and February 2018, 31 healthy volunteers, 31 UC patients without depression, and 31 UC patients with depression from Longhua Hospital were enrolled. Clinical data and fecal samples were collected for each patient. Fecal bacteria were identified using 16 s rRNA sequencing. We compared microbial composition among the 3 groups using bioinformatic analysis.

Patients with UC with depression had higher disease severity (P < .05). The UC without depression group had moderate reduction of microbial abundance and uniformity compared to the control group. The UC with depression group had the lowest microbial abundance. With regard to the vital bacteria in the microbiota-gut-brain axis, patients with UC and depression had the lowest abundance of Firmicutes, Clostridia, and Clostridiales but the highest abundance of Proteobacteria, Gammaproteobacteria, and Bacilli.

The presence of depression in UC patients presented significant differences in the composition of gut microbiota compared with UC patients without depression, with increased abundance of Firmicutes and reduced abundance of Proteobacteria.
Electroacupuncture for patients with spasticity after stroke
Authors: Yang Kang , Zhang Hongshi , Hu Guanyu , Zhang Ye , Lou Huijuan , Meng Meng , Wang Yufeng , Cong Deyu
Published: February 2021

Background:

The purpose of this paper is to evaluate the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke.

Methods:

We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-Fang Database from the date of creation to November 2020. In addition, we will manually retrieve other resources including the reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to electroacupuncture in the treatment of spasticity after stroke will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The modified Ashworth scale was the primary outcomes. Simplified Fugl–Meyer assessment scale (FMA), Stroke specific quality of life scale (SS-QOL) and adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis. If it is not appropriate for a meta- analysis, then a descriptive analysis will be conducted. Data synthesis will use the risk ratio and the standardized or weighted average difference of continuous data to represent the results.

Results:

This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke.

Conclusion:

This systematic review will provide evidence to judge whether electroacupuncture is an effective and safety intervention for patients with spasticity after stroke.

Ethics and dissemination:

The protocol of the systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences.

Systematic review registration:

CRD42021220300.
Review of economic analysis of available interventions on idiopathic short stature
Authors: Lee Boram , Kwon Chan-Young
Published: February 2021

Background:

Idiopathic short stature (ISS) causes a high economic burden worldwide. As part of a research project that synthesizes economic evidence for Korean medicine treatment of ISS, we describe the methods that will be used for the comprehensive review of articles that analyze health-related economic evaluation for available interventions for ISS using a systematic review methodology.

Methods:

Eight electronic English, Korean, and Chinese databases will be searched from their inception until December 2020 to identify studies on the economic evaluation of available interventions on ISS, without language, study design, or publication status restrictions. From the included studies, the effectiveness, utility, and cost data will be collected as the outcome measures by two researchers independently. Descriptive analysis of individual studies will be conducted. If it is judged that the interventions and outcomes of the included studies are sufficiently homogeneous, we will attempt a quantitative synthesis through meta-analysis using Review Manager version 5.4 software (Cochrane, London, UK).

Results:

This study will summarize the evidence regarding the economic evaluation of available interventions for ISS.

Conclusions:

The findings of this review will help clinicians and patients in evidence-based decision-making in clinical settings and help policy makers develop effective policies and distribute resources based on the available evidence.
Silver dressing in the treatment of diabetic foot
Authors: Huang Chunhua , Wang Ruiqi , Yan Zhangren
Published: February 2021

Background:

Diabetic foot (DF) is one of the most common and serious chronic complications of diabetes. At present, there are many dressings used in the treatment of the diabetic foot. Among them, silver dressings are widely used, but the conclusion has not yet been formed. The purpose of this study is to search for relevant studies on the treatment of DF with silver dressings through evidence-based medicine methods and to draw conclusions with higher levels of evidence to provide a basis for the clinical treatment of DF.

Methods:

Computer search of databases such as CNKI, SinoMed, VIP, Wanfang, PubMed, Embase, and Cochrane Library. The search time is from the establishment of the database to January 23, 2021. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The meta-analysis will be completed by RevMan 5.3 software.

Results:

This systematic review will provide an assessment of the current state of DF, aiming to assess the efficacy of silver dressings for patients with DF.

Conclusion:

This systematic review will provide a credible evidence-based for the clinical treatment of DF with silver dressings.
Genital Human Papillomavirus Infection in Indian HIV-Seropositive Men Who Have Sex With Men
Authors: Raghavendran Anantharam , Hernandez Alexandra L. , Lensing Shelly , Gnanamony Manu , Karthik Rajiv , Sivasubramanian Murgesan , Kannangai Rajesh , Abraham Priya , Mathai Dilip , Palefsky Joel M.
Published: February 2021

Background

The incidence of penile cancer in Indian men is high. Little is known about genital human papillomavirus (HPV) infection in Indian HIV-seropositive men who have sex with men (MSM), a population that may be at particularly high risk for genital HPV infection and, potentially, penile cancer. In this study, we assessed the prevalence and risk factors for genital HPV infection in this population.

Design and Methods

Three hundred HIV-seropositive MSM were recruited from 2 clinical sites in India. They were tested for genital HPV infection using L1 HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. Participants received an interviewer-administered questionnaire that included questions on demographics and behaviors.

Results

Human papillomavirus data were available from 299 participants. The prevalence of any HPV type in the penis and scrotum was 55% and 54%, respectively. Human papillomavirus type 35 was the most common oncogenic HPV type followed by HPV-16. In multivariate analysis, being the insertive partner with 100+ male partners increased the odds of any penile HPV infection compared with not being insertive with any partners (odds ratio, 2.5; 95% confidence interval, 1.3–5.1). Circumcision was protective against penile HPV infection (odds ratio, 0.39; 95% confidence interval, 0.19–0.76).

Conclusions

The prevalence of penile and scrotal HPV infection was high among Indian HIV-seropositive MSM. The most common oncogenic HPV type in this population, HPV-35, is not included in any currently available HPV vaccines. Insertive anal sex with men and lack of circumcision were the primary risk factors for penile HPV infection in this population.