bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of Cervical Prediction Models for Patient-Reported Outcomes at 1 Year After Cervical Spine Surgery for Radiculopathy and Myelopathy
Authors: Archer Kristin R. , Bydon Mohamad , Khan Inamullah , Nian Hui , Pennings Jacquelyn S. , Harrell Frank E. , Sivaganesan Ahilan , Chotai Silky , McGirt Matthew J. , Foley Kevin T. , Glassman Steven D. , Mummaneni Praveen V. , Bisson Erica F. , Knightly John J. , Shaffrey Christopher I. , Asher Anthony L. , Devin Clinton J.
Published: August 2020

Study Design.

Retrospective analysis of prospectively collected registry data.

Objective.

To develop and validate prediction models for 12-month patient-reported outcomes of disability, pain, and myelopathy in patients undergoing elective cervical spine surgery.

Summary of Background Data.

Predictive models have the potential to be utilized preoperatively to set expectations, adjust modifiable characteristics, and provide a patient-centered model of care.

Methods.

This study was conducted using data from the cervical module of the Quality Outcomes Database. The outcomes of interest were disability (Neck Disability Index:), pain (Numeric Rating Scale), and modified Japanese Orthopaedic Association score for myelopathy. Multivariable proportional odds ordinal regression models were developed for patients with cervical radiculopathy and myelopathy. Patient demographic, clinical, and surgical covariates as well as baseline patient-reported outcomes scores were included in all models. The models were internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients.

Results.

Four thousand nine hundred eighty-eight patients underwent surgery for radiculopathy and 2641 patients for myelopathy. The most important predictor of poor postoperative outcomes at 12-months was the baseline Neck Disability Index score for patients with radiculopathy and modified Japanese Orthopaedic Association score for patients with myelopathy. In addition, symptom duration, workers’ compensation, age, employment, and ambulatory and smoking status had a statistically significant impact on all outcomes (P < 0.001). Clinical and surgical variables contributed very little to predictive models, with posterior approach being associated with higher odds of having worse 12-month outcome scores in both the radiculopathy and myelopathy cohorts (P < 0.001). The full models overall discriminative performance ranged from 0.654 to 0.725.

Conclusions.

These predictive models provide individualized risk-adjusted estimates of 12-month disability, pain, and myelopathy outcomes for patients undergoing spine surgery for degenerative cervical disease. Predictive models have the potential to be used as a shared decision-making tool for evidence-based preoperative counselling.

Level of Evidence: 2.
Single-level Posterolateral Fusion (PLF) Alone and Posterior Interbody Fusion (PLIF/TLIF) Alone Lead to a Decreased Risk of Short-term Complications Compared to Combined PLF With PLIF/TLIF Procedures
Authors: Plantz Mark A. , Hsu Wellington K.
Published: August 2020

Study Design.

Retrospective review of a database cohort.

Objective.

To compare short-term outcome measures and complications between single-level posterolateral fusion (PLF), single-level posterior interbody fusion (PLIF/TLIF), and combined single-level PLF+PLIF/TLIF.

Summary of Background Data.

Both PLF and interbody fusion are well-established procedures for degenerative spinal disease. However, there is lack of consensus as to the ideal surgical approach for specific applications. Additionally, the difference in risk of complications with traditional PLF, interbody fusion with posterior approach, and circumferential fusion is still contested.

Methods.

The ACS NSQIP database was used to identify 24,228 patients who underwent either a single-level PLF, single-level PLIF/TLIF, or combined single-level PLF+PLIF/TLIF between 2014 and 2017. To control for potential confounding variables, exact matching was used to pair individuals from each treatment group based on several factors, including sex, age, body mass index, various comorbidities, and American Society of Anesthesiologists classification. After appropriate matching, the rate of various short-term outcome measures and complications were compared between the three treatment groups.

Results.

After exact matching, 13,251 patients were included in the final analysis. The rates of non-home discharge, overall surgical complications, and bleeding requiring transfusion were significantly lower in the PLF group and PLIF/TLIF group relative to the PLF+PLIF/TLIF group (P < 0.001 for all comparisons). The rate of deep venous thrombosis was lower in the PLIF/TLIF group relative to the PLF group (P = 0.006). There were no significant differences in other medical complications, unplanned readmission, reoperation, or return to the OR between any of the treatment groups.

Conclusions.

The combination of single-level PLF+PLIF/TLIF is associated with higher rates of short-term complications relative to either single-level PLF or PLIF/TLIF alone. The associated risks of this therapy should be considered when considering surgical management for lumbar disease.

Level of Evidence: 3.
Oligoprogression After Checkpoint Inhibition in Metastatic Melanoma Treated With Locoregional Therapy: A Single-center Retrospective Analysis
Authors: Comito Francesca , Leslie Isla , Boos Laura , Furness Andrew , Pickering Lisa , Turajlic Samra , Larkin James
Published: August 2020

Checkpoint inhibitors (CPIs) have demonstrated a heterogenous spectrum of response and disease progression that may not be fully captured by conventional response criteria, such as a limited degree of progression, known as oligoprogression, which could benefit from local treatment. We retrospectively analyzed data from all patients diagnosed with metastatic melanoma, who received CPI between January 2006 and March 2018 at Royal Marsden. We enrolled 36 patients who experienced progression in a maximum of 3 metastatic sites, after achieving disease control from therapy with CPI, and were radically treated with the locoregional approach. We carried out Kaplan-Meier analysis to obtain progression free-survival post-first oligoprogression (PFS-PO1), overall survival (OS) post-first oligoprogression, and OS estimates. The median time to oligoprogression from the start of CPI was 12 months. At a median follow-up of 34 months, the median PFS-PO1 was 32 months, with 50% of patients not progressed at the time of the data cutoff. The median OS-post-first oligoprogression was not reached. At a median follow-up of 52 months (from the first cycle of CPI), the median OS was not reached, with 75% of patients alive at the time of analysis. Univariate and multivariate analyses demonstrated that baseline American Joint Committee on Cancer stage IV M1a or M1b is associated with a longer PFS-PO1 compared with stage M1c or M1d. We observed that local therapy for oligoprogression after CPI can result in durable disease control, suggesting that locoregional treatment should be considered in patients being treated with immunotherapy. However, prospective evaluation, perhaps in randomized trials, is needed.
Hedgehog Pathway Alterations Downstream of Patched-1 Are Common in Infundibulocystic Basal Cell Carcinoma
Authors: Russell-Goldman Eleanor , MacConaill Laura , Hanna John
Published: August 2020

The infundibulocystic variant of basal cell carcinoma (BCC) is characterized histologically by anastamosing strands of basaloid epithelium with associated small infundibular-type cysts. Since its first description in 1987, this rare entity has generated considerable controversy with some authors classifying it as a benign follicular neoplasm rather than a BCC subtype. Prior studies aiming to settle this issue using immunohistochemical analysis reached opposite conclusions. The defining feature of BCC is activation of the Hedgehog signaling pathway, and mutations in Patched-1 (PTCH1) are the most common molecular finding in both sporadic and inherited forms of BCC. Mutations in other downstream components including Smoothened (SMO) and Suppressor of Fused (SUFU) also occur, but are much less common. Here, we report a molecular genetic analysis of a small series of infundibulocystic BCC using a next-generation DNA sequencing platform. All 4 cases harbored mutations or other genetic alterations in components of the Hedgehog pathway, supporting the classification of this entity as a BCC variant. Interestingly, these tumors were enriched for genetic alterations downstream of PTCH1, involving SUFU, SMO, GLI1, and GLI2. This observation was of particular interest given that rare kindreds of the Multiple Hereditary Infundibulocystic BCC syndrome (MHIBCC), which is related, but possibly distinct from the nevoid BCC syndrome, harbored mutations in SUFU. Our results support the classification of the infundibulocystic variant as a subtype of BCC, and suggest that the level at which genetic alterations occur within the Hedgehog pathway may be an important determinant of the morphologic features in BCC.
Aging Changes of the Superficial Fat Compartments of the Midface Over Time: A Magnetic Resonance Imaging Study
Authors: Cevik Cenkeri Halime , Sarigul Guduk Sukran , Derin Cicek Esin
Published: August 2020

BACKGROUND

Studies involving superficial facial fat compartments are few in number with conflicting results. Most of them involved small study groups and compared measurements between different populations of young and old subjects either on cadavers or living subjects.

OBJECTIVE

To clarify volumetric and dimensional changes in midfacial superficial fat compartment retrospectively in patients who underwent a repeat magnetic resonance imaging (MRI) without gross pathology.

MATERIALS AND METHODS

A total of 70 patients with a mean age of 60 years (range: 33–82 years) and a median elapsed time of 44.5 months (range: 32–64 months) between 2 MRIs were included. Magnetic resonance imaging scans were analyzed in the axial and sagittal planes to obtain measurements of the medial part of the superficial cheek fat. Superficial cheek fat was divided into 3 compartments. Thickness, width, and height were measured, and volumes were calculated for each compartment on both hemifaces.

RESULTS

Volume and thickness were decreased significantly in all compartments (p < .05). The width was decreased in superior and middle compartments, whereas increased in lower compartment indicating dislocation of the fat tissue (p < .05). Height was also significantly increased (p < .05). A subgroup analysis has shown that there was no significant difference between men and women.

CONCLUSION

This study clarifies that aging is associated with a significant decrease in superficial midfacial fat tissue volume and thickness both in women and men. The decrease in width in upper and middle compartments, but increase in lower compartment suggests a volume shift within superficial fat tissue.
A Prospective, Split-Face, Comparative Study of Combined Treatment With Fractional Microneedle Radiofrequency and Nonablative 1927-nm Fractional Thulium Fiber Laser for Wrinkle Treatment
Authors: Park Min-Young , Hwang Shinwon , Chun Soo Il , Kim Su Min , Almurayshid Abdurrahman , Oh Sang Ho
Published: August 2020

BACKGROUND

Fractional microneedle radiofrequency (FMR) and nonablative 1927-nm fractional thulium fiber laser (TFL) are widely used for skin rejuvenation treatment.

OBJECTIVES

To investigate the efficacy and safety of combined treatment with both devices for wrinkles.

PATIENTS AND METHODS

Twenty-five patients with wrinkles were enrolled. One side of the face was treated with FMR alone, while the other side was treated with a combination of FMR and TFL. Each treatment consisted of 3 sessions at four-week intervals and patients were followed up 12 weeks after the last treatment. Overall improvement was assessed by patient global assessment (PGA) and investigator global assessment (IGA). Depression scores for the evaluation of wrinkles were objectively assessed by Antera 3D system.

RESULTS

Both sides of the face led to clinical improvement in both mean PGA and IGA. Combination treatment demonstrated a greater improvement in both mean PGA and IGA compared with FMR alone. In addition, wrinkle grading scales and depression scores showed greater improvement in the combination group than in FMR alone.

CONCLUSION

This study demonstrated that FMR and TFL comprise a good combination treatment for the treatment of wrinkles because both treatments have a synergistic effect on wrinkle improvement.
The global impact of COVID-19 on infertility services
Authors: Ory Steven J. , Miller Kathleen A. , Horton Marcos , Giudice Linda
Published: August 2020

The COVID-19 pandemic has posed unique concerns and potential risks to women now pregnant or considering childbearing. Although no professional societies have issued recommendations that women avoid conception at this time, several professional organizations recommended a moratorium on infertility services including both medically assisted reproduction and assisted reproductive technology shortly after the World Health Organization declared COVID-19 infection to be a pandemic. Reasons cited for undertaking these extraordinary measures included prevention of possible complications of assisted reproductive technology and medically assisted reproduction and virus induced complications of pregnancy including potential vertical transmission to the fetus and optimization use of critical health care resources. A survey of reproductive health providers in 97 countries was undertaken to assess their response to the pandemic and recently issued guidance. Although different countries reacted differently with diverse responses and variable resources, the results suggest that the reproductive health community has largely been responsive to public health and individual patient concerns.
Systematic Review of Digital Phenotyping and Machine Learning in Psychosis Spectrum Illnesses
Authors: Benoit James , Onyeaka Henry , Keshavan Matcheri , Torous John
Published: August 2020

Background

Digital phenotyping is the use of data from smartphones and wearables collected in situ for capturing a digital expression of human behaviors. Digital phenotyping techniques can be used to analyze both passively (e.g., sensor) and actively (e.g., survey) collected data. Machine learning offers a possible predictive bridge between digital phenotyping and future clinical state. This review examines passive digital phenotyping across the schizophrenia spectrum and bipolar disorders, with a focus on machine-learning studies.

Methods

A systematic review of passive digital phenotyping literature was conducted using keywords related to severe mental illnesses, data-collection devices (e.g., smartphones, wearables, actigraphy devices), and streams of data collected. Searches of five databases initially yielded 3312 unique publications. Fifty-one studies were selected for inclusion, with 16 using machine-learning techniques.

Results

All studies differed in features used, data pre-processing, analytical techniques, algorithms tested, and performance metrics reported. Across all studies, the data streams and other study factors reported also varied widely. Machine-learning studies focused on random forest, support vector, and neural net approaches, and almost exclusively on bipolar disorder.

Discussion

Many machine-learning techniques have been applied to passively collected digital phenotyping data in schizophrenia and bipolar disorder. Larger studies, and with improved data quality, are needed, as is further research on the application of machine learning to passive digital phenotyping data in early diagnosis and treatment of psychosis. In order to achieve greater comparability of studies, common data elements are identified for inclusion in future studies.
The Feasibility and Validity of a Wearable Sensor System to Assess the Stability of High-Functioning Lower-Limb Prosthesis Users
Authors: Miller Kyle T. , Russell Molly , Jenks Terese , Surratt Kaddie , Poretti Kelly , Eigenbrot Samantha S. , Akins Jonathan S. , Major Matthew J.
Published: August 2020

Introduction

Lower-limb prosthesis users (LLPUs) experience increased fall risk due to gait and balance impairments. Clinical outcome measures are useful for measuring balance impairment and fall risk screening but experience limited resolution and ceiling effects. Recent advances in wearable sensors that can measure different components of gait stability may address these limitations. This study assessed feasibility and construct validity of a wearable sensor system (APDM Mobility Lab) to measure postural control and gait stability.

Materials and Methods

Lower-limb prosthesis users (n = 22) and able-bodied controls (n = 24) completed an Instrumented Stand-and-Walk Test (ISAW) while wearing the wearable sensors. Known-groups analysis (prosthesis versus controls) and convergence analysis (Prosthetic Limb Users Survey of Mobility [PLUS-M] and Activities-Specific Balance Confidence [ABC] scale) were performed on 20 stability-related measures.

Results

The system was applied without complications; however, missing anticipatory postural adjustment data points for nine subjects affected the analysis. Of the 20 analyzed measures output by the sensors, only three significantly differed (P < 0.05) between two cohorts, and two demonstrated statistically significant correlations with the self-report measures.

Conclusions

The results of this study suggest the clinical feasibility but only partial construct validity of the wearable sensor system in conjunction with the ISAW test to measure LLPU stability and balance. The sample consisted of high-functioning LLPUs, so further research should evaluate a more representative sample with additional outcome measures and tasks.
Big Data Analytics + Virtual Clinical Semantic Network (vCSN): An Approach to Addressing the Increasing Clinical Nuances and Organ Involvement of COVID-19
Authors: Rahman Fuad , Meyer Rick , Kriak John , Goldblatt Sidney , Slepian Marvin J
Published: August 2020

The coronavirus disease 2019 (COVID-19) pandemic has revealed deep gaps in our understanding of the clinical nuances of this extremely infectious viral pathogen. In order for public health, care delivery systems, clinicians, and other stakeholders to be better prepared for the next wave of SARS-CoV-2 infections, which, at this point, seems inevitable, we need to better understand this disease—not only from a clinical diagnosis and treatment perspective—but also from a forecasting, planning, and advanced preparedness point of view. To predict the onset and outcomes of a next wave, we first need to understand the pathologic mechanisms and features of COVID-19 from the point of view of the intricacies of clinical presentation, to the nuances of response to therapy. Here, we present a novel approach to model COVID-19, utilizing patient data from related diseases, combining clinical understanding with artificial intelligence modeling. Our process will serve as a methodology for analysis of the data being collected in the ASAIO database and other data sources worldwide.
Comparison of surgical outcomes of lumbar disc herniation using local anesthesia and epidural anesthesia
Authors: Wang Wei , Ni Bin-bin , Shen Hao , Lu Hua
Published: August 2020

We performed this meta-analysis to evaluate the effects of epidural anesthesia and local anesthesia on the surgical outcomes of lumbar disc herniation (DH).

Electronic databases including PubMed, EMBASE, Cochrane Library, and the Chinese Academic Journal Full-text Database were searched to identify randomized controlled trials (RCTs) that reported on the effects of local anesthesia and epidural anesthesia in lumbar DH surgical management. Evaluation indicators included: onset time of anesthesia, patient satisfaction, and the rate of adverse effects. There were 6 RCTs with a total of 606 patients in this meta-analysis: 274 cases in the local anesthesia group and 332 in the epidural anesthesia group.

This meta-analysis demonstrated that the epidural anesthesia group had a better analgesic effect, a lower adverse effect rate (mean difference [MD] = 0.21, 95% confidence interval [CI] [0.08, 0.54], P = .001) and a better satisfaction rate: (MD = 6.54, 95% CI [2.77, 15.45], P < .0001). The duration of anesthesia was not statistically significant.

Epidural anesthesia is a better choice for lumbar DH surgery compared to local anesthesia.
Diagnosis of ischemic optic neuropathy caused by dissection of the internal carotid artery
Authors: Zheng Xiangrong , Wang Yunpeng , Chen Guocang , Ma Chuanyong , Yan Weiming , Chen Meizhu
Published: August 2020

Rationale:

Ischemic optic neuropathy (ION), due to diseases of the arteries supplying the optic nerve, is an ischemic damage of the optic nerve. This report highlights a case with monocular decreasing visual acuity caused by dissection of the internal carotid artery (ICA), which is a relatively rare cause for ION.

Patient concerns:

A 44-year-old woman presented with a decreasing visual acuity and defected visual field in the right eye for 1 week. The best corrected visual acuity (BCVA) was 20/400 in the right eye, and 20/20 in the left eye. In the right eye, the pupil showed little reaction to light with a relative afferent pupillary defect. The visual field test disclosed a defect in the inferior field connecting to the blind spot. Electroretinogram recording showed no obviously declined retinal function. No recognizable waveforms were presented in pattern visual–evoked potential (PVEP) examination, whereas the flash visual–evoked potential result revealed a delayed peak time and a reduced amplitude of P2-wave.

Diagnosis:

The patient was diagnosed as ION with the aid of computed tomographic angiography of the brain and neck, which revealed a stenosis in the right ICA and an occlusion in the right cerebral middle artery. The stenosis was verified as dissection of the ICA by digital subtraction angiography.

Interventions:

Based on the clinical findings, stent implantation inside the right ICA was performed.

Outcomes:

The ICA was recanalized soon and the BCVA of the right eye was improved to be 20/25 five months later. A second PVEP examination revealed a recognizable waveform in the right eye, although the peak time and amplitude of the P100-wave was a bit abnormal compared to that of the left eye.

Lessons:

ION with the sign of decreasing monocular visual acuity could occur due to dissection of the ICA, with no obvious neurologic symptom at the beginning. The present case emphasizes the importance of suspicion of ICA problems as the underlying cause for ION, which could help to take in-time measure to save the vision and avoid further complications.
Prognostic value of serum calprotectin level in elderly diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Zhang Wutang , Kong Yongmei , Wang Lizhi , Song Lizhong , Tan Lijuan , Xue Xiaobo
Published: August 2020

Patients with acute coronary syndrome (ACS) have an increased serum level of calprotectin. The purpose of present study was to analyze the prognostic significance of serum calprotectin levels in elderly diabetic patients underwent percutaneous coronary intervention (PCI) due to ACS.

A total of 273 consecutive elderly diabetic patients underwent PCI for primary ACS were enrolled. Serum calprotectin levels were measured before PCI, and baseline clinical characteristics of all patients were collected. All patients were followed up at regular interval for major adverse cardiovascular events (MACEs) during 1 year after PCI. MACEs include cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization (TVR). The predicting value of serum calprotectin for MACEs was analyzed by using univariate and multivariate analysis and receiver-operating characteristic curve (ROC).

At the endpoint of this study, 47 patients of all 273 patients had MACEs. According to optimal cutoff value of calprotectin for predicting MACEs by ROC analysis, all patients were stratified into a high calprotectin group and a low calprotectin group. The incidence rate of MACEs and TVR in high calprotectin group was prominently higher than that in low calprotectin group (21.9% vs 11.5%, P = .02). In multivariable COX regression analysis adjusting for potential confounders, serum calprotectin level remains as an independent risk predictor of MACE (hazard ratio, 1.56; 95% confidence interval [CI]: 1.08–4.62; P = .01).

In diabetic patients with a comorbidity of ACS, a high serum level of calprotectin is associated to a higher MACE rate after PCI.
Hepatic fibrosis is associated with total proteinuria in Korean patients with type 2 diabetes
Authors: Han Eugene , Cho Yongin , Kim Kyung-won , Lee Yong-ho , Kang Eun Seok , Cha Bong-Soo , Lee Byung-wan
Published: August 2020

The association between non-alcoholic fatty liver disease (NAFLD) and diabetic kidney disease assessed using either albuminuria or proteinuria remains controversial. This study aimed to investigate the association between hepatic steatosis or fibrosis and albuminuria or proteinuria in Korean patients with type 2 diabetes mellitus (T2D).

We enrolled 1108 patients with T2D and categorized as 3 groups; non-proteinuria (NP), isolated non-albumin proteinuria (iNAP), and albuminuria. Urinary albumin and protein levels were assessed as urinary albumin-to-creatinine ratio (uACR) and urinary protein-to-creatinine ratio (uPCR), respectively. Hepatic steatosis and fibrotic burden were assessed using the NAFLD liver fat score, Fibrosis-4 calculator (FIB-4) index, and NAFLD fibrosis score (NFS).

The prevalence of significant steatosis was similar among groups (NP: 74.6% vs iNAP: 70.3% vs albuminuria: 79.9%, P = .085). The prevalence of significant fibrosis was significantly higher in the iNAP (18.7%) and albuminuria (16.5%) groups than in the NP group (9.5%, P = .001). Both uPCR and uACR showed a correlation with NFS (uPCR: r = 0.123, P < .001; uACR: r = 0.064, P = .033). In multivariate logistic regression analysis, uPCR ≥150 mg/g was found to have a stronger association with hepatic fibrosis than uACR ≥30 mg/g (adjusted odds ratio 1.55 [95% CI 1.03–2.33] vs adjusted odds ratio 1.16 [95% CI, 0.72–1.87]).

In conclusion, patients with iNAP and albuminuria had a higher prevalence of hepatic fibrosis than those without proteinuria. Total proteinuria was associated with advanced liver fibrosis, whereas albuminuria was related to hepatic steatosis.
Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis
Authors: Zhang Haitao , Zhou Minlin , Han Xiaoyan , Yang Yang , Yu Xin
Published: August 2020

Backgroud:

Mycophenolate mofetil (MMF) has been recommended for the treatment of lupus nephritis (LN). Although inter-racial differences exist regarding the appropriate dose and efficacy of MMF in patients with LN, no definitive meta-analysis has yet been conducted in Chinese patients. This analysis investigated the efficacy and safety of MMF in Chinese patients with proliferative LN.

Methods:

A systematic literature search was conducted to select randomized controlled trials that reported at least one of the following: complete remission (CR), partial remission, total remission (TR; defined as complete remission + partial remission), relapse rate, serum creatinine, creatinine clearance, end-stage renal disease, death, infections, amenorrhea, leukopenia, alopecia, gastrointestinal symptoms, or liver damage.

Results:

Eighteen trials (927 patients) were included; 14 (750 patients) reported CR, partial remission, and TR. Two trials (58 patients) reported relapse rates during maintenance treatment. MMF induction significantly improved CR and TR vs cyclophosphamide (relative risk 1.34, 95% confidence interval: 1.13–1.58;P < .001; relative risk 1.16, 95% confidence interval: 1.02–1.33;P = .03), and was associated with significantly lower risks of infection (P < .001), amenorrhea (P < .001), leukopenia, and alopecia. No significant difference in relapse rate was evident between the MMF and azathioprine groups (P = .66).

Conclusion:

According to this meta-analysis of 18 trials, MMF is significantly more effective than cyclophosphamide induction, and is associated with reduced incidences of infections, amenorrhea, leukopenia, and alopecia in Chinese patients with proliferative LN.
Diagnostic value of circulating tumor DNA in molecular characterization of glioma
Authors: Kang Yin , Lin Xiaohua , Kang Dezhi
Published: August 2020

Introduction:

Circulating tumor DNA (ctDNA) has provided a minimally invasive approach for the detection of genetic mutations in glioma. However, the diagnostic value of ctDNA in glioma remains unclear. This meta-analysis was designed to investigate the diagnostic value of ctDNA, compared with the current “criterion standard” tumor tissues.

Materials and methods:

The included studies were collected by searching PubMed, Web of Science, Cochrane Library, and Embase databases. All statistical analyses were performed using the STATA12.0 and Meta-DiSc1.4 software.

Result:

A total of 11 studies comprising 522 glioma patients met our inclusion criteria. The pooled sensitivity and specificity were 0.69 (95% confidence interval [CI] 0.66–0.73) and 0.98 (95% CI 0.96–0.99), respectively. The pooled diagnostic odds ratio was 23.27 (95% CI 13.69–39.53) and the area under the curve of the summary receiver operating characteristics curve was 0.90 (95% CI 0.89–0.92).

Conclusions:

ctDNA analysis is an effective method to detect the genetic mutation status in glioma patients with high specificity and relatively moderate sensitivity. The application of high-throughput technologies, the detection of patients with high-grade glioma, and sampling from cerebrospinal fluid could have higher diagnostic accuracy. The improvement of detection methods and more large-sample case–control studies are required in the future.
The effect of scalp electroacupuncture combined with Memantine in patients with vascular dementia
Authors: Yue Aixia , Han Xiuqing , Mao Enxia , Wu Guangling , Gao Junxiang , Huang Liping , Zhou Bin
Published: August 2020

Currently there is no effective treatment for vascular dementia (VaD). Pharmacological treatment often lead to severe complications and require drug dosage adjustment. This study investigated the effect of scalp electroacupuncture combined with Memantine in VaD. The safety and antioxidative effect of scalp electroacupuncture were also explored.

A retrospective study was conducted and data of inpatients of Linyi Central Hospital with VaD between June 2017 and May 2018 were collected and sorted. The patients were divided into scalp electroacupuncture-medication (A), scalp electroacupuncture (B) and medication (control) (C) groups, in which Memantine was prescribed as medication. Cognitive function, activities of daily living and quality of life assessed by Montreal Cognitive Assessment (MoCA), Barthel index and dementia quality of life questionnaire; the contents of superoxide dismutase, lipid peroxide and nitric oxide in blood samples; and adverse reaction were compared.

Data from a total of 150 patients were collected (Group A, n = 55; Group B, n = 50; Group C, n = 45). The post-treatment/follow-up Montreal Cognitive Assessment, Barthel index and dementia quality of life questionnaire scores were significantly improved in all groups compared to pre-treatment (groups A and B, P<.01; group C, P<.05). The improvements were significant for groups A vs C, B vs C (P<0.01, both), and group A vs B (P<.05). The post-treatment/follow-up levels of lipid peroxide and nitric oxide decreased significantly while superoxide dismutase increased significantly in groups A and B compared to pre-treatment (P<.01, both). The differences were significant for groups A vs C, and B vs C (P < .01, both), but not significant between groups A and B (P > .05). There were no significant adverse events occurred during the study and follow-up.

In combined treatment, scalp electroacupuncture works in parallel with Memantine and significantly increase the therapeutic effect in VaD with no significant adverse events. Scalp electroacupuncture may have the potential to serve as an option or alternative treatment for VaD. Scalp electroacupuncture may alleviate VaD symptoms through its antioxidative mechanism.
A child infected with severe acute respiratory syndrome coronavirus 2 presenting with diarrhea without fever and cough
Authors: Liu Qian , Zhang Yong , Long Yuan
Published: August 2020

Rationale:

Coronavirus disease 2019 (COVID-19), now a global pandemic, has spread to a large number of countries around the world. Symptoms of COVID-19 can range from mild to severe, including fever, cough, shortness of breath, and pneumonia. Some cases even remain asymptomatic. Data regarding the epidemiological and clinical features of children with COVID-19 are limited. Symptoms in children are thought to be atypical when compared with adults. As a result, diagnosis in many children is likely to be missed. Children presenting with atypical symptoms, especially those with a history of exposure, should be referred to early screening.

Patient concerns:

A 23-month-old boy presented with a 2-day history of diarrhea. Chest computed tomography scan showed pneumonia. After admission to the hospital, the patient exhibited no diarrhea or other symptoms. Positive presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, was confirmed by 5 consecutive rounds of nucleic acid amplification testing of nasopharyngeal swabs. The patient was also found to have liver damage.

Diagnosis:

Swabs were obtained for detection of SARS-CoV-2 RNA by established methods.

Interventions:

Chinese traditional medicine prescription

Outcomes:

Following treatment, signs of pneumonia on computed tomography scans were observed to be partially absorbed, and 2 consecutive rounds of nucleic acid amplification testing of swab samples were negative. The patient was discharged on the 21st day after admission to the hospital. On the 21st day after discharge, the patient had no recurrence of disease, no recurrence of pulmonary lesions, and normal liver function.

Conclusion:

This case study suggests that diarrhea not explained by common causes, such as acute gastroenteritis, could be a preliminary symptom of SARS-CoV-2 infection in children. Despite the lack of the presence of a fever or cough, lung pulmonary lesions were present in this child. SARS-CoV-2 infection may also cause hepatic injury. Even during the SARS-CoV-2 pneumonia recovery period, IgM and IgG antibodies can be positive for a long time.
Effect of comprehensive psychosomatic promotion in hypertension patients with anxiety and depression based on community
Authors: Zhang Hailiang , Jiang Xiaomei , Da Haixia , Dai Runjing , Zhao Na , Pan Weimin , Fan Jingchun
Published: August 2020

Background:

Mental health is closely related to the occurrence of hypertension, particularly the prognosis of hypertension patients. The role of psychotherapy in the occurrence, development, prevention, and prognosis of hypertension, remains to be clarified.

Methods/design:

We will conduct a prospective, double-blind, randomized, multiple-centers study. Eighty patients enrolled in this trial will be randomized at 1:1 ratio. The primary endpoint is will be the reduction of the patient psychological scale (PHQ-9) score. Secondary endpoints will be the drop in blood pressure, awareness of physical and mental health and self-efficacy scale. Measurements will be performed at baseline, 5-week (questionnaires only), 10-week (primary endpoint), using the Anxiety Screening Questionnaire (GAD-7) and Depression Scale (PHQ-9). Data analysis will be carried out using the SPSS v.25 software assuming a level of significance of 5%. Results will be analyzed using multilevel, regression analysis and hierarchical linear models.

Discussion:

We hope to provide some insight in the understanding the underlying mechanism of the novel mindfulness in the management of hypertension related psychological stress/disturbance, and will enable us to develop novel approach to manage essential hypertension and its related psychological disorders.

Clinical trial registry:

http://www.chictr.org.cn (ChiCTR1900028258)
Breast reconstruction after complications following breast augmentation with massive filler injections
Authors: Kim Hyeon Jo , Lee Seong Joo , Lee Ju Ho , Shin Se Ho , Kim Seong Hwan , Kim Jae Hyun , Suh In Suck
Published: August 2020

Introduction:

Breast filler injections are less commonly used due to their associated complications, such as pain and foreign body reactions. Yet, these fillers are often administered illegally, resulting in aesthetic or life-threatening complications. These are treated by removing the foreign material, and the breasts are reconstructed using silicone implants or autologous tissue/fat injection.

Patient concerns:

Case 1. A 45-year-old woman with polyacrylamide gel injections in both breasts visited our clinic for breast pain and tenderness. Grade I ptosis was observed in each breast, without skin necrosis and discoloration. Case 2. A 51-year-old woman, with unknown breast filler injections, visited our clinic for painful masses. Intraoperatively, massive amounts of foreign material had severely infiltrated the nearby tissues; thus, an immediate breast reconstruction could not be performed. Three months later, severe deformities including shrinkage and irregular breast skin surfaces were observed.

Diagnosis:

Case 1. Multiple cystic lesions, fluid collection in the retromammary spaces, and diffuse infiltration were observed on mammography, computed tomography, and ultrasonography. Case 2. Multiple cystic lesions, calcified areas, and diffuse infiltrations in the axillae and retromammary spaces were observed on mammography, computed tomography, and ultrasonography.

Interventions:

Case 1. The foreign material was removed and the breasts were reconstructed using silicone implants into subpectoral pocket with acellular dermal matrices (Alloderm, Lipocell Corporation). Case 2. A delayed reconstruction was undertaken using silicone implants covered by latissimus dorsi muscle flaps, 3 months after the foreign material removal.

Outcomes:

Case 1. The foreign material was removed and there were no complications such as foreign body reaction, capsular contracture. Ptosis was corrected and both breasts were symmetric with proper projection. Case 2. Residual foreign material was removed and there were no complications such capsular contracture, implant malposition.

Conclusion:

Massive injections of foreign materials into the breast can cause severe infiltration and associated foreign body reactions. By a near-complete removal of the foreign materials and breast reconstruction using silicone implants, we achieved satisfactory results, without complications such as wound disruption, capsular contracture, and implant malposition.
Examination of pain relief effect of Goreisan for glossodynia
Authors: Ayuse Takao , Okayasu Ichiro , Tachi-Yoshida Mizuki , Sato Jun , Saisu Hironori , Shimada Masahiko , Yamazaki Yoko , Imura Hiroko , Hosogaya Naoki , Nakashima Sawako
Published: August 2020

Background:

Pain in glossodynia may be severe; it may prevent patients from working, interfere with daily life activities, and necessitate a patient's visit to a medical institution for consultation and treatment. The pain may be described as persistent and burning (tingling, tingling) or stinging. Patients may complain of dry mouth (dryness), which is thought to cause inflammation of the tongue and gingival mucous membranes and increased pain. Medications are prescribed based on the symptoms of glossodynia, and the therapeutic effect is confirmed. However, each drug has side effects, for example, pain may reduce, but drowsiness and dizziness may occur; further, there is always a tendency of drowsiness.

On the other hand, Goreisan, a Chinese herbal medicine, has already been used by physicians to treat pain in the oral and maxillofacial regions resulting from rapid changes in air pressure. However, the lack of high-quality clinical research has been of concern, and a randomized clinical trial to investigate the efficacy and safety of Goreisan for treatment of pain in glossodynia is warranted.

Methods/design:

This multicenter, randomized, controlled study will involve patients treated for glossodynia-related pain. In the experimental group, Goreisan will be taken for 12 weeks in combination with conventional treatment. Participants in the control group will not take any Kampo medicine; only the standard treatment will be taken. Subsequently, the degree of pain will be assessed, and saliva tests of all the patients on their first visit will be performed. Goreisan will be taken at a dose of 7.5 g/d (minute 3) for 12 consecutive weeks. Twelve weeks later, the degree of pain of each patient will be assessed.

Discussion

The purpose of this study is to investigate the efficacy of Goreisan for pain reduction in patients undergoing treatment for glossodynia-related pain. If pain in glossodynia patients can be reduced by the administration of Goreisan, its candidacy as an alternative treatment for pain in glossodynia can be further supported by more reliable research.

Trial registration:

The study was registered in the jRCTs071200017. URL https://jrct.niph.go.jp/latest-detail/jRCTs071200017.
Pediatric massage therapy for restoring pediatric lung function from COVID-19
Authors: Zhou Ke-Lin , Dong Shuo , Wang Kang , Fu Guo-Bing , Niu Yan , Xue Xiao-Na , Guo Sheng
Published: August 2020

Background:

The novel coronavirus disease 2019 (COVID-19) has caused an international outbreak of a respiratory illness and grown to be a global public health emergency since patients were first detected in Wuhan, China. Given the rapidly growing pandemic and the overwhelmed medical system, there is an urgent need of alternative medicine to help children relieve symptoms during self-quarantine, and possibly to help increase their chances of survival and recovery from COVID-19. By using various manual techniques at specified locations on the surface of the body, pediatric massage manipulation can unblock meridians, promote the circulation of qi and blood and strengthen resistance to pathogens.

Methods:

We will search the following electronic databases: Wanfang and Pubmed Database, CNKI, CENTRAL, CINAHL, EMBASE and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses.

Results:

This systematic review will evaluate the existing evidence of pediatric massage therapy for restoring pediatric lung function from COVID-19. The outcomes will include the improvement of pulmonary function and adverse effect.

Conclusion:

This proposed systematic review will evaluate the existing evidence and explore the potential role of pediatric massage therapy on the effectiveness and safety in pulmonary function of COVID-19 convalescent children.

PROSPERO registration number:

CRD42020193396
Observation on the clinical effect of thunder-fire moxibustion combined with acupressure on ocular muscle spasm
Authors: Cao Yi-fei , Li Tie-jun , Xu Yong-mei , Zhang Yi , Nian Jia-yun , Li Qiang , Ma Qiu-yan , Liu Yu , Li Ying , Wu Yan , Yang Chao , Cui Peng-li , Lü Yu-yan , Yang Ying-xin , Zheng Yu-hong
Published: August 2020

Introduction:

With the rapid development of social economy, peoples dependence on computers and mobile phones is increasing day by day. This causes people to often overuse. Therefore, the incidence of Ocular muscle spasm has been increasing year by year in recent years. The disease usually starts and hides, which seriously affects the patients social image, daily life, and work.

Methods/design:

We will compare the clinical efficacy of thunder-fire moxibustion combined with acupressure with pure thunder-fire moxibustion on Ocular muscle spasm using random control method.

Discussion:

We aim to find a simple, safe, simple and effective Chinese medicine nursing technology that relieves Ocular muscle spasm.

Trial registration:

ClinicalTrials.gov,ChiCTR2000034187, Registered on 27 June 2020.
Safety and efficacy of apatinib combined with iodine-125 in chemotherapy-refractory advanced lung cancer
Authors: Zhang Yunchao , Yin Shiqiang , Jia Yingjie , Qin Lei
Published: August 2020

Introduction:

Apatinib is a novel anti-angiogenic agent that targets vascular endothelial growth factor receptor-2, and is effective in patients with advanced lung cancer who are refractory to first-line chemotherapy. However, there are limited reports on concurrent apatinib therapy with iodine-125 radioactive seeds brachytherapy in elderly patients with advanced lung cancer.

Patient concerns:

We describe the first reported case of a 70-year-old woman with advanced lung cancer (T3N3M1, stage IV) who received concurrent apatinib and iodine-125 radioactive seeds brachytherapy after the failure of platinum-based doublet chemotherapy

Diagnosis:

The patient was diagnosed with left lower lung cancer with mediastinal lymph node metastasis by chest computed tomography.

Interventions:

Initially, apatinib alone was used as second-line cancer therapy. Subsequently, the patient received concurrent apatinib and iodine-125 radioactive seeds brachytherapy.

Outcomes:

The patient achieved partial response shortly after undergoing treatment with only apatinib. During the treatment, the tumor continued to respond to apatinib therapy, and the lung metastases were diminished eventually. However, a chest computed tomography scan showed a large cavity in the lung tumor. Thereafter, the patient received concurrent apatinib and iodine-125 radioactive seeds brachytherapy. Unfortunately, she died due to pulmonary infection.

Conclusion:

Apatinib alone may be a good second-line therapy for advanced lung cancer patients who are refractory to platinum-based doublet chemotherapy. However, its potential benefits, especially as combination therapy, need further investigation by future prospective clinical studies. Elderly patients with advanced lung cancer may benefit from concurrent apatinib with iodine-125 radioactive seeds brachytherapy when chemotherapy is not tolerated or effective. Further studies are needed to investigate the clinical outcomes and toxicities associated with concurrent apatinib and radiation therapy in patients with advanced lung cancer.