bluuebunny/crossref_metadata_2025 huggingface dataset:
Core outcome set for stable angina pectoris in traditional Chinese medicine (COS-SAP-TCM)
Authors: Zhang Mingyan , Zhang Junhua , Chua Hui Zi , Feng Rui , Lu Meijuan , Tian Ying
Published: November 2021

Objective:

This study aimed to develop a core outcome set (COS) for use in future studies of stable angina pectoris (SAP) in traditional Chinese medicine (TCM).

Methods:

Systematic literature reviews and qualitative interviews with cardiologists and patients with SAP treated using TCM were conducted to generate a set of outcomes. Outcomes were prioritized by stakeholders via two rounds of an online Delphi survey and face-to-face consensus meetings. Following the final consensus meeting, a final COS was generated.

Results:

An initial set of 324 outcomes was identified. A preliminary list of 65 outcomes was employed in the Delphi study. In total, 223 participants from seven stakeholder groups were invited to score outcomes in the first Delphi round: 87 completed round 1 and 47 completed round 2. Thirty-one participants attended the consensus meeting and agreed on a final core set of outcomes comprising six items across four domains: frequency of angina attack, duration of angina attack, Seattle angina questionnaire, total exercise duration in the exercise treadmill test, cardiovascular events, and QT interval on electrocardiography.

Conclusions:

The COS developed in this study provides the minimum requirements for measurement and reporting in future TCM clinical trials for the treatment of SAP. The employment of this COS may reduce heterogeneity across trials and facilitate evidence-based decision-making for stakeholders.
Septic Superior Ophthalmic Vein Thrombosis in a Prothrombotic Adolescent Patient
Authors: Ray Hetal , Megalla Marez , Linderman Wendy , Habib Larissa
Published: November 2021

A 14-year-old boy presented to the emergency room with 5 days of fever and periorbital edema and erythema refractory to 4 days of augmentin and clindamycin. Examination revealed normal visual acuity, mild left periorbital edema and erythema, and a (−)1 supraduction deficit, concerning for orbital cellulitis. CT imaging revealed pansinusitis, orbital cellulitis with subtle orbital fat stranding, and a dilated superior ophthalmic vein with concern for thrombosis. This was confirmed on subsequent magnetic resonance venography. He was treated with intravenous antibiotics and enoxaparin with significant improvement in 24 hours. Standard hypercoagulable workup revealed positive lupus anticoagulant and cardiolipin of unclear significance; on genetic sequencing, he was found to have a homozygous mutation of the
4G
variant of
plasminogen activator inhibitor-1
.
Plasminogen activator inhibitor-1
homozygosity is a rare predisposing hypercoagulable state. This case highlights the importance of hematologic and genetic studies in adolescent patients with superior ophthalmic vein thrombosis, particularly those with mild presentation.
The Köllner Tarsoconjunctival Flap for Lower Eyelid Reconstruction: Historical Perspective and Surgical Outcomes of 140 Cases
Authors: Custer Philip L. , Maamari Robi N.
Published: November 2021

Purpose:

While Wendell Hughes popularized the tarsoconjunctival flap for lower eyelid reconstruction, most modern procedures are derived from the technique described by Köllner in 1911. This study reviews the history, techniques, and outcomes of a large series of patients treated with a modified Köllner flap.

Methods:

In this observational cohort study, medical records and photographs were reviewed in patients undergoing surgery between 2005 and 2020. Patient demographics, complications, secondary interventions, and outcomes were evaluated.

Results:

Marginal defect size ranged from 12 to 41 mm among the 140 study patients. Ancillary procedures included lower eyelid conjunctival flaps (n = 64) and septal orbicularis flaps (n = 68). The anterior lamella was reconstructed with skin grafts (n = 86), flaps (n = 10), or combined flaps/grafts (n = 44). Pedicle division was performed 23 to 84 days after primary repair. Subsequent interventions included steroid injection (n = 10), cryotherapy (n = 10), marginal erythema treatment (n = 9), and upper eyelid retraction repair (n = 6). Tearing (6.5%) and dryness (10%) were the most common postoperative symptoms, with most patients (78.6%) being asymptomatic. A good-excellent functional outcome was achieved in 94.3% and cosmetic outcome in 85.0% of cases. Defects <30 mm in width (P = 0.0001), defects not involving a canthus (P = 0.0158), and upper eyelid skin graft donor sites (P = 0.0001) were associated with better outcomes.

Conclusions:

The Köllner tarsoconjunctival flap is an effective technique to repair moderate-large lower eyelid defects, with the majority of patients achieving good-excellent cosmetic and functional outcomes. Factors associated with a poorer result include marginal eyelid defects ≥30 mm in width, defects involving a canthus, and non–upper eyelid skin graft donor sites. Most patients are asymptomatic after surgery.
Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy
Authors: Parker Richard T. , Vahdani Kaveh , Rose Geoffrey E.
Published: November 2021

Purpose:

To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland.

Methods:

Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland’s orbital lobe on an intact sheet of periosteum, an anterior “flip” of the mass (out of the orbit, past the orbital rim) “hinged” at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass.

Results:

Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19–85 years) and 51.1 years without (median, 50.3; range, 11–81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6–15.0 ml with osteotomy; 0.9–15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size.

Conclusions:

In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.
Specifying Adult Interaction Practices as a Step Toward Enhancing Our Conceptualization of Process Quality
Authors: Ford Andrea L. B. , Hugh Maria L. , Johnson LeAnne D. , Young Kelsey A.
Published: November 2021

Current conceptualizations of process quality in early childhood education highlight a variety of global classroom indicators that directly link to improved child outcomes. This conceptualization may need to be extended, however, to facilitate more meaningful change in children's development and readiness for kindergarten. To enhance our current definitions of process quality, we propose a set of more specific, observable adult interaction practice elements as a complement to existing global indicators within structural process elements and the broader preschool classroom ecology. We describe and define three practice types, as well as the individual practice elements within them, to include: (a) adult-led interaction practices, (b) child-led interaction practices, and (c) differentiated scaffolding. In operationalizing each practice element, we also provide empirical evidence as grounding for its inclusion in our conceptualization. We discuss implications and future practice and policy directions.
Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting
Authors: Carson Savanna L. , Hong Clemens , Behforouz Heidi , Chang Emily , Dixon Lydia Z. , Factor Diane , George Sheba M. , Lewis Jenebah , Majeno Angelina , Morales Maria , Porter Courtney , Shah Ami , Vassar Stefanie D. , Brown Arleen F.
Published: November 2021

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.
Nutrition senolytics - illusion or reality for cognitive ageing?
Authors: Chen Xi , Brodaty Henry , O’Leary Fiona
Published: November 2021

Purpose of review

Cell senescence is implicated in numerous age-related conditions. Antiageing therapies and nutritional approaches have been researched for purposes of removing senescent cells (senolytics) to treat or prevent age-related diseases, such as cognitive impairment and Alzheimer's disease. In this updated review, we examined the evidence from the last 18 months regarding nutrition senolytics, with a focus on cognitive ageing among older adults.

Recent findings

Overall, 19 systematic reviews and 17 intervention studies were included. Studies failed to provide evidence of nutritional senolytic agents or senescence-associated secretory phenotype (SASP) suppressors, for oral supplements providing beneficial effects on cognitive ageing among older adults. The protective role of food sources such as berries and nuts, and dietary patterns of Mediterranean diet and Mediterranean-DASH diet Intervention for Neurodegenerative Delay diet against cognitive decline or risk of dementia have been mostly supported by recent studies.

The present review gathered additional evidence for both oral supplements and foods/diets rich in nutritional senolytic agents or SASP suppressors on cognitive health among older adults. In pursuing antiageing strategies, the importance of whole foods and healthy diets should not be overlooked, future studies are warranted on long-term effects and cytotoxicity of nutritional senolytics.
EUS-CGN versus EUS-CPN in pancreatic cancer
Authors: Li Mao , Wang Zihe , Chen Yang , Wu Zuowei , Huang Xing , Wu Chao , Tian Bole
Published: November 2021

Background:

Comparison between endosonographic ultrasonography (EUS)-guided celiac ganglia neurolysis (CGN) and EUS-guided celiac plexus neurolysis (CPN) in pain management for pancreatic cancer has engendered controversy. To analyze the effectiveness and safety of EUS-CGN and figure out whether EUS-CGN is better than EUS-CPN, a qualitative systematic review was conducted.

Methods:

Studies were searched from Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE up to April 2020. We only included studies with full-text and in English and assessed study quality with Newcastle-Ottawa Scale or Cochrane risk-of-bias tool. We recorded details of study design, participants, procedure performed, protocol of follow-up, pain response, quality of life, survival, and adverse events. The study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009.

Results:

Five studies involving 319 patients were included. Short-term pain response rates ranged from 65.0% to 88.46% in EUS-CGN group and most studies reported its superiority over EUS-CPN. As for adverse events, the incidence of transient hypotension and gastrointestinal symptoms seemed comparable, while results of initial pain exacerbation varied among studies. Besides, EUS-CGN might provide a shorter survival.

Conclusion:

EUS-CGN can be safely performed while it may shorten survival. In terms of short-term pain response, EUS-CGN is better than EUS-CPN while no conclusion of long-term pain control can be drawn.
Giant cell tumor of the cervical spine treated by carbon ion radiotherapy
Authors: Sakuda Tomohiko , Furuta Taisuke , Okimoto Tomoaki , Adachi Nobuo
Published: November 2021

Introduction:

Giant cell tumor (GCT) of the bone is a benign–malignant intermediate tumor with locally destructive growth and a relatively high local recurrence rate. Neurological symptoms may develop in patients with GCT of the spine, and surgical treatment is prioritized in cases where resection is possible. However, the local recurrence rate of GCT of the bone is higher than that of GCT at other sites owing to the associated surgical challenges, and treatment is often difficult. No study to date has reported long-term remission of recurrent tumors for more than 5 years by treatment with carbon ion beam radiotherapy after resection of GCT of the cervical spine.

Patient concerns:

A 14-year-old boy who experienced recurrence after surgery for GCT of the cervical spine.

Diagnosis:

The patient presented with cervical pain, and computed tomography revealed a mass of the C2 vertebral body. He underwent surgery for tumor resection and autologous bone grafting, and the final pathological diagnosis was GCT. The transplanted bone exhibited gradual progression of resorption, and recurrent tumors were observed on computed tomography and magnetic resonance imaging 1 year and 4 months after surgery.

Interventions:

The patient was started on denosumab at 15 years of age and received carbon ion beam therapy with 70.4 Gy administered in 32 sessions over 7 weeks.

Outcomes:

No progressive tumor growth was observed, there were no neurological symptoms such as paralysis or pain were noted, and the patient was in remission for 5 years after irradiation.

Conclusion:

These findings suggest that carbon ion radiotherapy is a safe and effective therapeutic option for patients with recurrent GCT of the cervical spine.
Comparison of the effect of traditional Chinese medicine injection combined with chemotherapy and chemotherapy alone on the prognosis, quality of life and immune function in patients with ovarian carcinoma
Authors: Xu Xingnong , Zhu Li , Long Lin
Published: November 2021

Background:

The effectiveness of traditional Chinese medicine (TCM) in assisting the reduction of the toxic effects of chemotherapy and enhancing the efficacy of chemotherapy is gradually being recognized. Traditional Chinese medicine injection (TCMJ) has been widely used as a promising adjuvant drug in the treatment of ovarian carcinoma. However, the exact clinical efficacy and safety of TCMJ have not been well studied due to the wide variety. This study aims to conduct a network meta-analysis of randomized controlled trials (RCTs) about comparing the effect of TCMJ combined with chemotherapy and chemotherapy alone on the treatment of ovarian cancer, thus summarizing the effects of TCMJ on the prognosis, quality of life and immune function of ovarian carcinoma patients, and providing a reference for developing therapeutic regimens for ovarian carcinoma.

Methods:

Randomized controlled trials reporting the effect of TCMJ combined with chemotherapy and chemotherapy alone on the prognosis, quality of life and immune function in patients with ovarian carcinoma published before September 2021 will be screened out from online databases like PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database. Subsequently, 2 researchers will be independently responsible for literature screening, data extraction and assessment of their quality. All data will be processed by R.4.1.0.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusions:

Evidence-based medicine supports the efficacy and safety of TCMJ combined with chemotherapy for the treatment of ovarian carcinoma, which is better than that of chemotherapy alone.

Ethics and dissemination:

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF REGISTRATION NUMBER:

DOI 10.17605/OSF.IO/P93VJ.
Rebooting the ambulatory enterprise in a community medical group in Kentucky following the initial surge of COVID-19
Authors: Shields Lisa B.E. , Hester Steven T. , Johnson Craig , Hamilton Randy , Honaker Joshua T.
Published: November 2021

The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.
The clinical characters and prognosis of COVID-19 patients with multiple organ dysfunction
Authors: Cui Jianghua , Yuan Boyun , Li Yan , Li Zhu , Yuan Yadong
Published: November 2021

To depict the clinical characters and prognosis of coronavirus disease 2019 patients who developed multiple organ dysfunction syndrome (MODS).

A cohort consisted of 526 patients, which including 109 patients complicated MODS, was retrospectively analyzed to examine the clinical characteristics and risk factors of MODS.

Among the 526 novel coronavirus-infected pneumonia patients, 109 patients developed multiple organ failure, the incidence rate was 20.7%. Among all 109 patients with MODS, 81.7% were over 60 years old, and 63.3% were male. The most common symptoms were fever (79.8%), dyspnea (73.4%), and fatigue (55.0%). Compared with patients non-MODS patients, there were 70 cases of MODS patients with one or more underlying diseases (64.2% vs 41.0%, P < .001). Respiratory failure (92.7%), circulatory failure (52.0%), and liver function injury (30.9%) were the most common symptoms within the spectrum of MODS. Invasive ventilator, noninvasive ventilator, and high-flow respiratory support treatment for patients in MODS patients were higher than those in the non-MODS group (P < .001). The antiviral therapy and 2 or more antibacterial drug treatments in MODS patients were higher than those in the non-MODS group (P < .001). The median hospital stay of all patients was 16 days (interquartile range [IQR], 9-26), of which 20 days (IQR, 11.5-30.5) in the MODS patients, which was approximately 4 days longer than that of non-MODS patients. In addition, our data suggested that lymphocyte counts <1.0 ∗ 109/L, Troponin T > 0.014 ng/mL and lower oxygenation index were risk factors for MODS. In the early stage of hospital admission, higher inflammatory indexes and lactic acid concentration were associated with increased risk of death.

MODS often leads to poor prognosis in coronavirus disease 2019. Our data suggested the importance of early identification of MODS. We recommend close monitoring and timely supportive therapy for patients with high risks, stopping the disease progression before it was too late.
Cervical cancer screening varies by HPV vaccination status among a National Cohort of privately insured young women in the United States 2006–2016
Authors: Ba Djibril M. , McCall-Hosenfeld Jennifer S. , Ssentongo Paddy , Chinchilli Vernon M. , Agbese Edeanya , Liu Guodong , Leslie Douglas L. , Du Ping
Published: November 2021

Human papillomavirus (HPV) vaccination in young women is low. Women aged 21 to 65 years in the United States (U.S.) have not reached the Healthy People 2020 objective of 93% for cervical cancer screening. The main aim of this study was to investigate the association between HPV vaccination status and cervical cancer screening among privately insured women aged 21 to 26 years in the U.S.

This was a retrospective cohort study using the IBM MarketScan database (2006–2016). The study population included 190,982 HPV-vaccinated women and 763,928 matched unvaccinated women. Adjusted incidence rate ratio (IRR) and the 95% confidence intervals (CIs) were obtained using the generalized estimating equations models with a Poisson distribution.

Among a total of 954,910 women included in the analysis, age (mean [SD]) was 23.3 [1.6] years. During 967,317 person-years of follow-up, a total of 475,702 incidents of cervical cancer screening were identified. The incidence density rates of cervical cancer screening were 461 per 1000 person-years (PY) for unvaccinated women and 787 per 1000 PY for those who received 3 doses of the HPV vaccine. After adjusting for other covariates, the IRR of cervical cancer screening was 34% higher among HPV-vaccinated women with at least one vaccine dose than unvaccinated women (adjusted IRR = 1.34, 95% CI: 1.33–1.35; P < .0001). The IRR of cervical cancer screening varied by the dose of HPV vaccination. There was evidence of a linear dose–response relationship between the number of HPV vaccine doses and cervical cancer screening (P-trend < .0001). Compared with unvaccinated women, the IRR of cervical cancer screening were 14%, 39%, and 60% higher among those who received 1, 2, and 3 doses of the HPV vaccine, respectively.

In this large retrospective cohort study of privately insured women, HPV-vaccinated women were more likely to be screened for cervical cancer compared with unvaccinated women.
Detection and characterization of COVID-19 findings in chest CT
Authors: Gashi Andi , Kubik-Huch Rahel A. , Chatzaraki Vasiliki , Potempa Anna , Rauch Franziska , Grbic Sasa , Wiggli Benedikt , Friedl Andrée , Niemann Tilo
Published: November 2021

The COVID-19 pandemic has challenged institutions’ diagnostic processes worldwide. The aim of this study was to assess the feasibility of an artificial intelligence (AI)-based software tool that automatically evaluates chest computed tomography for findings of suspected COVID-19.

Two groups were retrospectively evaluated for COVID-19-associated ground glass opacities of the lungs (group A: real-time polymerase chain reaction positive COVID patients, n = 108; group B: asymptomatic pre-operative group, n = 88). The performance of an AI-based software assessment tool for detection of COVID-associated abnormalities was compared with human evaluation based on COVID-19 reporting and data system (CO-RADS) scores performed by 3 readers.

All evaluated variables of the AI-based assessment showed significant differences between the 2 groups (P < .01). The inter-reader reliability of CO-RADS scoring was 0.87. The CO-RADS scores were substantially higher in group A (mean 4.28) than group B (mean 1.50). The difference between CO-RADS scoring and AI assessment was statistically significant for all variables but showed good correlation with the clinical context of the CO-RADS score. AI allowed to predict COVID positive cases with an accuracy of 0.94.

The evaluated AI-based algorithm detects COVID-19-associated findings with high sensitivity and may support radiologic workflows during the pandemic.
Safety and efficacy of Prunella vulgaris preparation in adjuvant treatment of thyroid nodules
Authors: Han Qing , Xu Ning , Chen Bo , Wu Wei , Sheng Lei
Published: November 2021

Background:

Prunella vulgaris (PV), a traditional Chinese medical herb, is considered beneficial for some thyroid diseases. However, the effectiveness is not consistent in different studies. This review compiles the evidence from randomized controlled trials (RCTs) and quantifies the effects of PV preparation on thyroid nodules.

Methods:

Eight databases were searched up to April 2021 to identify eligible studies. Only RCTs were included. Meta-analysis of homogeneous studies was performed by RevMan5.3 software. Cochrane risk of bias assessment tool version 2.0 was used to assess the risk of bias of each trial. The research screening, data extraction, and risk of bias assessment were employed by 2 reviewers independently, and disagreement will be decided by a third senior reviewer. The risk ratio (RR), mean difference (MD) and corresponding 95% confidence interval (CI) of each study are summarized.

Results:

Thirteen RCTs with 1468 patients were included in this study. A meta-analysis showed that the RR of the clinical efficacy of PV combined with levothyroxine sodium tablets was 1.22 (95% CI [1.11, 1.33]). The MD of thyroid nodule diameter was −0.43 (95% CI [−0.63, −0.22]). The MD of free triiodothyronine and free tetraiodothyronine levels was −1.99 (95% CI [−3.14, −0.86]) and −3.20 (95% CI [−5.50, −0.89]), respectively. The RR of the adverse reaction rate was 0.67 (95% CI [0.36, 1.22]), and the RR of the clinical efficacy of PV preparation combined with thyroxin tablets was 1.29 (95% CI [1.03, 1.62]).

Conclusions:

PV combined with levothyroxine sodium tablets or thyroxin tablets has more benefits for thyroid nodules, further improving the clinical efficiency, reducing the diameter of nodules and reducing the occurrence of adverse reactions. However, the quality of these studies is uncertain, and higher quality and more RCTs are needed to provide comprehensive evidence-based medical evidence in the future.
Associations between angiogenic factors and intravoxel incoherent motion-derived parameters in diffusion-weighted magnetic resonance imaging of breast cancer
Authors: Lee Youn Joo , Kim Sung Hun , Kang Bong Joo , Son Yo Han , Grimm Robert
Published: November 2021

Intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) can be used to estimate perfusion-related parameters, but these parameters may differ, based on the curve-fitting algorithm used for IVIM. Microvessel density (MVD) and vascular endothelial growth factor (VEGF) status are used as angiogenic factors in breast cancer. We aimed to investigate the relationship between MVD, VEGF, and intravoxel incoherent motion (IVIM)-derived parameters, obtained by 4 curve-fitting algorithms, in patients with invasive breast cancers.

This retrospective study investigated IVIM-derived parameters, D (ie, tissue diffusivity), D∗ (ie, pseudodiffusivity), and f (ie, perfusion fraction), of 55 breast cancers, using 10 b values (range, 0–800 s/mm2) and 4 curve-fitting algorithms: algorithm 1, linear fitting of D and f first, followed by D∗; algorithm 2, linear fitting of D and f and nonlinear fitting of D∗; algorithm 3, linear fitting of D and f, linear fitting of D∗, and ignoring D contribution for low b values; and algorithm 4, full nonlinear fitting of D, f, and D∗. We evaluated whole-tumor histograms of D, f, and D∗ for their association with MVD and VEGF.

D∗
10, D∗
25, D∗
50, D∗
mean, D∗
75, D∗
90, f10, and f25, derived using algorithm 3, were associated with VEGF expression (P = .043, P = 0.012, P = .019, P = .024, P = .044, P = .041, P = .010, and P = .005, respectively). However, no correlation existed between MVD and IVIM-derived parameters.

Perfusion-related IVIM parameters obtained by curve-fitting algorithm 3 may reflect VEGF expression.
A randomized controlled trial to explore the efficacy and safety of transcranial direct current stimulation on patients with post-stroke fatigue
Authors: Dong Xiang-Li , Sun Xing , Sun Wei-Ming , Yuan Qin , Yu Guo-Hua , Shuai Lang , Yuan Ye-Feng
Published: November 2021

Background:

Post-stroke fatigue seriously affects the quality of life for stroke patients. There is no effective treatment at present. transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation which may have therapeutic effect on post-stroke fatigue. This study will explore about this.

Method:

A total of 60 patients with post-stroke fatigue were randomly divided into the control group and the treatment group with 30 patients each by minimization randomization. Both groups received basic treatment and conventional rehabilitation. In the treatment group, patients were treated with active tDCS, while in the control group, sham tDCS. Both active and sham tDCS were administered 6 times a week for 4 weeks. Before and after the trial, the Fatigue Severity Scale (FSS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) were evaluated and analyzed. And comparisons were made among groups. And there were an 8-week follow-up after the intervention.

Result:

Before the intervention, there were no significant differences in baseline data and assessment scores between the groups (P > 0.05). After 4 weeks of intervention, FSS scores in the treatment group were significantly lower than those in the control group (P = 0.012), and FMA and BMI scores were significantly higher than those in the control group (P < 0.05). There was no significant change in FSS scores after 8 months of follow-up (P > 0.05).

Discussion:

TDCS is a safe treatment that can effectively reduce the degree of fatigue after stroke, improve the motor function and daily activity ability of patients after stroke, and the efficacy is better than only routine rehabilitation training.

Trial registration number:

Chinese Clinical Trial Registry, ChiCTR2000031120. Registered on March 22, 2020.
Vitamin D deficiency in pregnant women
Authors: Chen Bo , Chen Yongquan , Xu Yuanhong
Published: November 2021

Objective:

To analyze the level of vitamin D and its influencing factors in pregnant women, and to explore the influence of vitamin D deficiency on common adverse pregnancy outcomes in pregnant women, providing evidence for prevention and intervention of vitamin D deficiency in pregnant women.

Methods:

The basic data and blood samples of pregnant women in our hospital from January 2019 to June 2020 were collected, and the 25-(OH) D levels of the serum samples were detected. Then the vitamin D levels and its influencing factors were analyzed, and the relationships between vitamin D levels and common adverse pregnancy outcomes in the pregnant women as well as the incidence of small-for-gestational-age newborns were analyzed.

Results:

The vitamin D deficiency rate, insufficiency rate and sufficiency rate of pregnant women were 83.28%, 15.36%, and 1.36% respectively, with vast majority of the pregnant women in a state of vitamin D deficiency. Analysis of the influencing factors on the vitamin D level of pregnant women showed “28 weeks ≤ gestational age ≤32 weeks, summer and autumn, high school education and above, weekly time outdoors ≥10 hours, supplement of vitamin D and trace elements during pregnancy” were protective factors for vitamin D sufficiency in pregnant women. Linear correlation analysis showed the vitamin D level of pregnant women was highly positively correlated with temperature, the higher the temperature, the higher the vitamin D level (r = 0.907, t = 6.818, P < .001). The level of vitamin D in pregnant women was related to the occurrence of spontaneous abortion and small-for-gestational age (SGA), with the incidence of spontaneous abortion and SGA in the “vitamin D deficiency group” higher than those of other groups (P = .018, P = .016).

Conclusions:

The vitamin D level of pregnant women in this area is relatively low, which is affected by multiple factors such as gestational age, season, education level of pregnant women, weekly time outdoors, vitamin D and trace element supplement during pregnancy. Low vitamin D levels can increase the risk of spontaneous abortion and SGA in pregnant women, so relevant measures should be adopted to improve the vitamin D status of pregnant women.
The value of positron emission tomography computed tomography in predicting invasiveness of ground glass nodules
Authors: Xiao Jitao , Li Mengle , Du Qun , Han Hailin , Ge Yinglin
Published: November 2021

Background:

The study was conducted to investigate the value of Positron emission tomography computed tomography (PET/CT) in predicting invasiveness of ground glass nodule (GGN) by the method of meta-analysis.

Methods:

Two researchers independently searched for published literature on PET/CT diagnosis of GGN as of November 30, 2020. After extracting the data, RevMan5.3 was used to evaluate the quality of the included literature. The Stata14 software was used to test the heterogeneity of the original study that met the inclusion criteria, to calculate the combined sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, the prior probability and posttest probability. The summary receiver operator characteristic curve was drawn and the area under the curve was calculated. Using Deeks funnel plot to evaluate publication bias.

Results:

Five studies were finally included, including 298 GGN cases. The included studies had no obvious heterogeneity and publication bias. The combined sensitivity and specificity of PET/CT for predicting invasive adenocarcinoma presenting as GGN were 0.74 (95% confidence interval [CI]: 0.68–0.79), 0.82 (95% CI: 0.71–0.90), positive likelihood ratio and negative likelihood ratio were 4.1 (95% CI: 2.5–6.9), 0.32 (95% CI: 0.25–0.40), and the diagnostic odds ratio was 13 (95% CI: 7–26). The prior probability is 20%, the probability of GGN being invasive adenocarcinoma when PET/CT was negative was reduced to 7%, and the probability of GGN being invasive adenocarcinoma when PET/CT was positive was increased to 51%. The area under the curve of the summary receiver operator characteristic curve was 0.85.

Conclusion:

PET/CT has high diagnostic accuracy for invasive adenocarcinoma presenting as GGN.
Describing the spine surgery learning curve during the first two years of independent practice
Authors: Ferguson Devin P. , Stevens Madison T. , Stewart Samuel A. , Oxner William M. , Dunning Cynthia E. , Glennie R. Andrew
Published: November 2021

Retrospective cohort study

To characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.

The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.

Data from a retrospective cohort (2014–2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1–Q4), with STATA software used for statistical analysis.

There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes–119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7–3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6–2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7–1.9]; P > .05) between surgeons.

A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.
Evaluation of the effectiveness and safety of cupping therapy in the treatment of asthma
Authors: Guo Lei , Wang Lie , Wang Zhongtian , Wei Lina , Ding Lizhong , Kong Yibu , Liu Zhimei , Tian Ye , Yang Fushuang , Sun Liping
Published: November 2021

Background:

Asthma is one of the most common chronic airway diseases and is characterized by wheezing, dyspnea, chest tightness, and coughing. These symptoms reduce the patient's quality of life and limit physical activity in daily life. However, there is no systematic review of the efficacy of cupping therapy in the treatment of asthma. To evaluate the efficacy and safety of cupping in the treatment of asthma, we conducted a systematic review and meta-analysis of published randomized clinical trials of cupping in the treatment of asthma.

Methods:

We will search the following Chinese and English databases: China National Knowledge Infrastructure, China Science and Periodical Database, Wanfang Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library. All of the above electronic databases will be searched from inception to August 22, 2021. In addition, we will manually search for conference papers, ongoing experiments, and internal reports to supplement the studies retrieved via electronic search. We will use the Review Manager 5.4 provided by Cochrane Collaboration Network for statistical analysis.

Results:

The study will prove the effectiveness and safety of cupping in the treatment of asthma.

Conclusion:

We plan to submit this systematic review to a peer-reviewed journal.

INPLASY registration number:

INPLASY202180104.
Efficacy and safety of traditional Chinese medicine injections combined with FOLFOX4 regimen for gastric cancer
Authors: Zhang Yanyan , Jiang Lihao , Ouyang Ju , Du Xianfeng , Jiang Longlong
Published: November 2021

Background:

Traditional Chinese medicine injections (TCMJs) combined with FOLFOX4 regimen could achieve favorable effects in the treatment of gastric cancer. However, the efficacy and safety of different TCMJs combined with FOLFOX4 in the treatment of gastric cancer have not been fully clarified. Due to the fact that there are as many as 10 kinds of TCMJs, how to choose an appropriate TCMJ has become an urgent clinical problem. The objective of this network meta-analysis is to explore the optimal options among different TCMJs for gastric cancer.

Methods:

PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data were searched to identify randomized controlled trials which focused on TCMJs combined with FOLFOX4 against gastric cancer from its inception to September 2021. Subsequently, 2 researchers will be independently responsible for literature screening, data extraction, and assessment of their quality. Standard pair-wise and Bayesian network meta-analysis will be performed to compare the efficacy and safety of different TCMJs combined with FOLFOX4 regimen via Stata 14.0 and WinBUGS1.4 software.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusions:

The conclusion of this systematic review will provide evidence for selecting an optimal TCMJ combined with FOLFOX4 for patients with gastric cancer.
Pain and physical activity changes during the COVID-19 state of emergency among Japanese adults aged 40 years or older
Authors: Hirase Tatsuya , Okita Minoru , Nakai Yuki , Akaida Shoma , Shono Saki , Makizako Hyuma
Published: November 2021

Understanding the relationship between pain and physical activity (PA) levels is beneficial for maintaining good health status. However, the impact of pain on changes in PA during the coronavirus disease 2019 (COVID-19) pandemic is unknown. The purpose of this study was to examine whether PA levels pre-, during, and post-COVID-19 state of emergency differ between Japanese adults who had pain after the COVID-19 state of emergency and those who did not.

Data were collected from a cross-sectional online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1967 Japanese adults aged ≥40 years who completed the online survey. Participants completed questionnaires on the presence of pain and duration of PA, defined as the total PA time per week based on activity frequency and time. Participants were asked to report their PA at 3 time points: October 2019 (before the COVID-19 pandemic), April 2020 (during the COVID-19 state of emergency), and October 2020 (after the COVID-19 state of emergency).

Among participants aged ≥60 years who reported pain in October 2020, the total PA time was significantly lower than participants who did not report having pain. Furthermore, the total PA time in April 2020 was significantly lower than that in October 2019; however, no significant difference in total PA time was observed between April and October 2020. Among participants aged 40 to 59 years, no significant differences were observed in total PA times at the 3 time points between those with and without pain. In addition, the total PA time in October 2020 significantly increased compared to that in April 2020, although it significantly decreased in April 2020 compared to October 2019.

This study suggests that older adults with pain have lower PA levels after the COVID-19 state of emergency.
Prediction of carpal tunnel syndrome using the thenar muscle cross-sectional area by magnetic resonance imaging
Authors: Yi Jungmin , Jeong Hye-Won , Cho Hyung Rae , Kang Keum Nae , Lee Jonghyuk , Lee Sooho , Cho Jaeho , Bang Yun-Sic , Kim Young Uk
Published: November 2021

Carpal tunnel syndrome (CTS) is a common neuropathy. Although CTS progression is known to be associated with thenar muscle (TM) atrophy, the diagnostic value of TM atrophy for CTS has not been established. In this research, the thenar muscle cross-sectional area (TMCSA) was evaluated to analyze the relationship between the TMCSA and CTS. We assumed that TMCSA is a major diagnostic parameter in the CTS.

Both TMCSA and thenar muscle thickness (TMT) samples were acquired from 18 CTS patients, and from 18 control subjects who underwent wrist magnetic resonance imaging with no evidence of CTS. T2-weighted transverse magnetic resonance imaging images were obtained. We measured the TMCSA and TMT at the level of first carpometacarpal joint.

The average TMCSA was 296.98 ± 49.39 mm2 in the normal group and 203.36 ± 72.13 mm2 in the CTS group. The average TMT was 8.54 ± 1.45 mm in the normal group and 7.38 ± 1.14 mm in the CTS group. CTS group had significantly lower TMCSA and TMT. Receiver operator characteristics curve analysis showed that the best cutoff point for the TMCSA was 260.18 mm2, with 77.8% sensitivity, 77.8% specificity. The best cutoff point of the TMT was 7.70 mm, with 61.1% sensitivity, 66.7% specificity.

Although the TMCSA and TMT were both significantly associated with CTS, the TMCSA was a much more sensitive measurement parameter. Thus, to evaluate CTS patients, the physician should more carefully inspect the TMCSA than TMT.
Re-irradiation of multiple brain metastases using CyberKnife stereotactic radiotherapy
Authors: Zhou Han , Wu Tiancong , Zhu Xixu , Li Yikun
Published: November 2021

Introduction:

Brain metastasis (BM) is the commonest adult intracranial malignancy and many patients with brain metastases require two course radiotherapy. Re-irradiation is frequently performed in Radiotherapy (RT) departments for multiple brain metastases.

Patient concerns:

We present a case of a 55-year-old male patient suffering from brain metastases, who had previously received whole-brain radiotherapy (WBRT) and first CyberKnife Stereotactic Radiotherapy (CKSRT) for metastases, presented with a recurrence of metastasis and new lesions in the brain.

Diagnoses:

An enhanced computed tomography (CT) scan of the brain revealed abnormalities with double-dosing of intravenous contrast that identified >10 lesions scattered in the whole brain.

Interventions:

Re-irradiation was performed using CKSRT. The patient was treated with 30 Gy in 5 fractions for new lesions and 25 Gy in 5 fractions for lesion that were locally recurrent and close to brainstem lesions.

Outcome:

The lesions were well-controlled, and the headache of the patient was significantly relieved one month after radiotherapy. The total survival time of the patients was 17 months from the beginning of the Cyberknife treatment.

Conclusion:

The present case report demonstrates that CyberKnife therapy plays a significant role in the repeated radiotherapy for multiple metastatic brain tumors. CKSRT can be used as a salvage method in recurrent multiple brain metastases.
Internet parent–child interaction therapy (I-PCIT) in medically ill child
Authors: Melo Valeria , Zaccariello Michael , Girard Emma , Croarkin Paul , Romanowicz Magdalena
Published: November 2021

Introduction:

This case illustrates the feasibility, benefit, and putative enhanced ecological validity of performing internet-parent–child interaction therapy (I-PCIT) in the parent–child dyad's home for the treatment of behavior problems in medically ill children in the context of a global pandemic.

Patient concerns:

Parents of a 5-year-old girl initially presented with concerns regarding inattentiveness, physical and verbal fighting with her siblings, and getting kicked out of daycare for hitting another child. Patient also had difficulties sleeping at night.

Diagnoses:

Patient was diagnosed with electrical status epilepticus in sleep, frontal lobe executive function deficit, and attention deficit hyperactivity disorder.

Interventions:

Patient received a course of I-PCIT. Equipment included a cell phone with video capabilities connected to a videotelephony software program and set-up in the child's home by the parents. The treatment course included 8, 1-hour, weekly teaching/coaching sessions (7 of which were performed using I-PCIT) plus 1 follow-up booster session 6 months later.

Outcomes:

Home-based I-PCIT implementation greatly improved disruptive behaviors in a young child with electrical status epilepticus in sleep and attention deficit hyperactivity disorder.

Conclusion:

A combination of I-PCIT and methylphenidate allowed her to be successful at home and in a school setting. More research is needed on PCIT adaptations, such as home-based and internet-based PCIT, for medically ill children as well as treatment protocols for combined therapies.