bluuebunny/crossref_metadata_2025 huggingface dataset:
P720 Similar risk of infection with SARS-CoV-2 in immunocompromised and immunocompetent patients with inflammatory bowel disease and healthy controls
Authors: Kante B , Vuyyuru S K , Gupta R , Dwivedi T , Kumar P , Mundhra S , Golla R , Virmani S , Verma M , Makharia G , Ahuja V , Kedia S
Published: January 2022

Background

The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in immunocompromised and immunocompetent IBD patients and healthy controls.

Methods

Patients with IBD under follow-up at the IBD clinic, All India Institute of Medical Sciences, New Delhi, were included. After obtaining informed consent, patients underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Seimens kit IgG against antigen S1RBD) and information on demography, drug history, past history of COVID infection and vaccination status were noted. Patients with IBD on 5-aminosalicylic acid or not on any treatment were considered immunocompetent and those who had received steroids, thiopurines or methotrexate within 6 months of sample collection were considered immunocompromised.

Results

235 patients (51.9%-males; mean age at enrolment-38.7±12.4 years; median disease duration-60 months [IQR:36–120]) (UC-69.4%, CD-28.9%, IBDU-1.7%) and 73 healthy controls (HCs- mean age-39.6± 10.9 years, 79% males) were enrolled from July 2020 - April 2021 (Table1). 128 (54.5%) patients were immunocompromised and 107 were immunocompetent (treatment details: 5 ASA-72.3%, steroids-15.3%, Thiopurines-40%, methotrexate-2.6%). Seventy-four (31.5%) patients were positive for IgG antibody against SARS CoV2, 2 patients (0.9%) had previous history of COVID infection and none received COVID vaccine. Seroprevalence rates between immunocompromised and immunocompetent patients with IBD and healthy controls was similar (28.1% vs 36% vs 28%, p>0.05) (Figure1). Demographic and disease characteristics such as age, gender, disease type, disease activity in last 6 months, disease duration and medication use was similar between patients with positive and negative serology (Table2). There was progressive increase in seroprevalence from July 2020 to April 2021

Conclusion

Upto 1/3rd patients with IBD were seropositive for IgG SARS Cov2 antibody indicating asymptomatic COVID-19 infection. The seroprevalence was similar to healthy controls and was not different between immunocompromised and immunocompetent patients with IBD.
N11 Development of a young person clinic for 16-24-year-olds with Inflammatory Bowel Disease (IBD), using a multidisciplinary team (MDT) approach
Authors: Hamzawi M , Hickey Y , Brannick S , Brett Kilmurray O , Jones F , Sheridan J , Cullen G
Published: January 2022

Background

In Ireland, the transition process is ad hoc with no formal guidelines on how to conduct transition clinics. This nurse-led project, aimed to develop a specific young person clinic for adolescents and provide information to adolescents and their families on the service they were joining, before their first clinic visit, subsequently reducing anxiety and improving outcomes.

Providing the right care for young people with IBD, in the right place, at the right time, where the patient is a priority, is the end goal.

Methods

The successful implementation of this project is due to the collaborative work of a multidisciplinary team using the Health Service Executive (HSE), Peoples Needs Defining Change Guide (2018). This change model provides clear definitive steps to Define, Design and Deliver innovative projects.

The model was applied as follows:

Define

Raise awareness of the need for adolescent clinic

Activate a core change team

Develop a vision in line with the organisational culture

Design

Propose a care pathway for adolescents including transition.

Design an informative ‘Welcome Booklet’

Arrange Virtual Meet and Greet (due to Covid restrictions)

Deliver

Open communication with all relevant stakeholders

Determine a time suitable for recurring adolescent clinic

Seek input from patients, colleagues and communication team to develop an informative ‘Welcome Booklet’

Results

The CIPP evaluation model, Context, Input, Process and Product, complimented this change model as formative evaluation throughout. This ensured the change process was streamlined with the values and vision of all stakeholders involved.

Context –SWOT analyses was undertaken, and Goals defined

Input – Strategy was defined and stakeholder analyses

Process –Monthly MDT meetings, design model of care, welcome booklet. Plan virtual introductory meetings due to Covid unable to meet face to face in the paediatric hospital

Product – Dedicated recurring clinic time for 16–24-year-olds with IBD to include transition clinics.

100% of parents and 80% of adolescents found the welcome booklet informative and useful.

100% both adolescents and parents found the introductory WebEx meeting beneficial.

Commenced RCT to look at best format for transition clinics going forward

Conclusion

(HSE), Peoples Needs Defining Change Guide (2018) provided the essential toolkit to ensure leadership, teamwork, the importance of stakeholders while keeping the patient central to all decisions made in developing young person’s clinics for 16-24-year-olds with IBD.
N12 Systematic Review: The role of psychological stress in Inflammatory Bowel Disease
Authors: Black J , Sweeney L , Yuan Y , Singh H , Norton C , Czuber-Dochan W
Published: January 2022

Background

Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in Inflammatory Bowel Disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured. This study aims to explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD.

Methods

A systematic review was performed. Medline, CINAHL, Embase, and PsycInfo databases were searched. Prospective studies recruiting people with IBD 16 years old or over and measuring psychological stress or distress were included.

Results

Thirty-eight studies, from 41 reports, with 4757 people with IBD were included in the review. Studies used thirty-six different instruments to measure stress. Perceived stress was the most frequently studied concept and was found to precede IBD disease exacerbation. Depression and helplessness were positively associated with perceived stress, while social support, resilience, and quality of life were negatively associated. Cognitive-behavioural group programmes may reduce stress and education, stress management, and exercise and other group programmes may reduce disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits.

Conclusion

Psychological stress appears to precede IBD disease exacerbation, though what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research is needed to examine the differential effects of stress on disease subtypes and IBD in flare and remission.
N16 ‘Same storm, different boat’… Exploring the impact of the COVID-19 pandemic on patients with Inflammatory Bowel Disease, with or without shielding: a qualitative study
Authors: Kemp K , Avery P , Bryant R , Cross A , Danter K , Kneebone A , Morris D , Walker A , Whitley L , Dibley L
Published: January 2022

Background

During the Covid-19 pandemic, patients with Inflammatory Bowel Disese (IBD) were advised about shielding based on clinical risk assessment. We explored experiences of IBD patients who did or did not shield during three UK lockdowns.

Methods

Participants aged 18 years+ with a confirmed diagnosis of Crohn’s disease, Ulcerative Colitis or IBD-Unclassified, who had shielded or not during any lockdown period were recruited from Crohn’s and Colitis UK. Semi-structured online or phone interviews (captured February-May 2021) were audio-recorded, transcribed professionally, and analysed using thematic analysis.

Results

Of 43 participants, 24 shielded; median age 38 years (19–63 years); 27 (62.7%) females; diagnosed with Crohn’s Colitis (n=2), Crohn’s disease (n=21), Ulcerative colitis (n=18) and IBD-Unclassified (n=2). Median disease duration 13 years (0.6–36 years). Participants were assessed as high (n-=10), moderate (n=23) and low (n=10) risk. Four main themes emerged: Vulnerability and Risk; IBD Preparedness; The Two Faces of Janus and Transitions.

Vulnerability and Risk

The ‘Clinically Extremely Vulnerable’ label caused alarm, despite bringing benefits. Conflicting information caused confusion; some made their own decision about risk which did not always match official advice. Participants felt vulnerable to higher risk caused by others’ behaviour. Some feared catching Covid.

IBD Preparedness

Living with IBD prepared participants for shielding/social distancing. Many felt others now appreciated their usual world of periods of isolation and missing out on social events. Some realised the need to take their IBD more seriously.

The Two Faces of Janus

The pandemic brought benefits and challenges to most participants. Working/studying from home often impacted positively on symptoms such as urgency and fatigue, as work and travel-related stresses eased. Loss of physical social contact with others was very distressing; many adopted new wellbeing activities to overcome social isolation. Few found the pandemic experience wholly positive.

Transitions

the experience of lockdown changed over time, as did shielding patterns. The easing of restrictions (March-June 2021) left shielding and non-shielding participants feeling confused, since they felt the risk remained. Some participants continued to shield or be socially distant, often mistrusting others to behave responsibly.

Conclusion

The pandemic had positive and negative effects for shielding and non-shielding participants alike. Adherence to Government shielding and/or social distancing guidelines was threatened by rising concerns about mental health and wellbeing. Any patient, regardless of official risk status, may need support to re-integrate socially.
N01 Type of patient education impacts the willingness to switch from an IV to SC of a biological in patients with Inflammatory Bowel Disease: A multicentre, comparative study
Authors: De Dycker E , Hoefkens E , Asnong K , Geens P , Lembrechts N , Lambrechts T , Van de Schoot I , Paps A , Vermeire S , Pouillon L , Ferrante M , Bossuyt P
Published: January 2022

Background

Subcutaneous (SC) formulations of CT-P13 and vedolizumab (VED) are currently available as new treatment option for patients with inflammatory bowel disease (IBD). The decision to switch requires a shared decision making based on adequate education of the patient, to avoid negative outcomes due to a nocebo effect. The aims of this study were (1) to evaluate the percentage of patients with IBD in favour of switching to SC formulations and (2) to compare two educational strategies.

Methods

This was a multicentre study in patients with IBD on maintenance intravenous (IV) CT-P13 or VED. Patients attending the infusion unit were invited to complete a survey exploring the willingness to switch to SC formulations. In centre A, all patients were informed on the new SC formulations and the accompanying care pathway by an information leaflet and a face-to-face interaction with the IBD nurse, prior to completing the survey. In centre B, patients on a minimal interval of q8w were digital invited to the same survey via the e-health application of the hospital. Demographics, patient reported outcomes, willingness to switch and reasons for IV vs. SC preferences were captured.

Results

In total, 447 (n=183 Centre A; n=264 Centre B; participation ratio 83.6%) patients completed the survey (m/f: 212/235; CD/UC/IBD-U: 275/161/11; median age 45 IQR 33–57; remission CD/UC: 75%/82%) see table. Most patients were open to SC treatment (47% yes, 33% doubt, 20% no). The main driver to switch was an anticipated decrease in hospital visits (86%) and overall time gain (78%). The main reason to continue IV was fear of change (60%) and uncertainty in case of relapse after switch to a SC formulation (46%). In univariate analysis, the self-estimated compliance rate was associated with the willingness to switch (p<0.0001). To evaluate the impact of the approach in patient education between the two centres, we compared the subgroup of patients on ≥q8w interval with a dosing of 5-10mg/kg CT-P13 or 300 mg VED (n=335). The willingness to switch was higher after a face-to-face approach (centre A) compared to a merely digital approach (centre B; 53.9 % vs. 40.9 % p=0.038), although patients in centre B had a higher educational level (p=0.003), more prior experience with other IBD SC medication (p=<0.001), lived further from the hospital (p<0.001) and had a younger age at diagnosis (p=0.019).

Conclusion

In this multicentre comparative study exploring the willingness to switch from IV to SC maintenance therapy with CT-P13 and VED, the majority is open to switch to a SC formulation. The direct approach and education of the patient by the IBD nurse impacts significantly the willingness to switch. In a follow-up we will investigate the actual switch rates.
Monitoring Circulating Immune Checkpoint Proteins as Predictors of Non-AIDS Morbid Events in People With HIV Initiating Antiretroviral Therapy
Authors: Premeaux Thomas A , Moser Carlee B , McKhann Ashley , Hoenigl Martin , Yeung Stephen T , Pang Alina P S , Corley Michael J , Lederman Michael M , Landay Alan L , Gianella Sara , Ndhlovu Lishomwa C
Published: January 2022

Background

Although cell surface immune checkpoint proteins (ICPs) such as PD-1 expressed on T cells are associated with T-cell exhaustion, HIV disease progression, and AIDS events, they have shown limited utility in predicting non-AIDS morbidity. Given that ICPs also exist in soluble forms and are elevated in ART-treated HIV infection, we tested the hypothesis that soluble ICPs may be predictive of non-AIDS events in adults initiating ART.

Methods

Utilizing a nested case–control study from the AIDS Clinical Trials Group ALLRT cohort, we measured plasma levels of 15 soluble inhibitory and activating ICPs by Luminex. Participants (134 cases, 292 matched controls) were evaluated pre-ART, a year post-ART, and immediately preceding a non-AIDS event, which included myocardial infarction (MI)/stroke, malignancy, serious bacterial infection, and nonaccidental death.

Results

Conditional logistic regression analysis determined that higher levels of soluble CD27 were associated with increased risk of non-AIDS events at all time points. Higher levels of CD40 at baseline and pre-event and CD80 at pre-event were associated with increased risk of non-AIDS events. Examining specific non-AIDS events, multiple ICPs were associated with malignancy at baseline and pre-event, whereas only higher CD27 levels were associated with increased risk of MI/stroke at year 1 and pre-event.

Conclusions

While select soluble ICPs were associated with non-AIDS events, CD27 emerged as a consistent marker irrespective of ART. Our data may offer guidance on new targets for early clinical monitoring in people with HIV who remain at greater risk of specific non-AIDS events.
Proton decay in SUSY GUTs
Authors: Hisano Junji
Published: January 2022

We review proton decay in the SUSY SU(5) GUTs assuming the mini-split SUSY breaking model. In the mini-split SUSY breaking model, the squark and slepton masses are O(10(2 − 3)) TeV while the gaugino masses are O(1) TeV. As the result, even the minimal SUSY SU(5) GUT is still viable in the model. We present the motivation of the mini-split SUSY model and discuss the future prospects of proton decay searches in the SUSY SU(5) GUTs.
Fracture-Associated Microbiome and Persistent Nonunion: Next-Generation Sequencing Reveals New Findings
Authors: Goswami Karan , Tipton Craig , Clarkson Samuel , Chang Gerard , Tan Timothy L. , Fram Brianna , Chisari Emanuele , Sobol Keenan , Natoli Roman M. , Conway Janet D. , Altman Gregory T. , Parvizi Javad , Krieg James C.
Published: January 2022

Introduction:

Fracture nonunion remains a devastating complication and may occur for several reasons, though the microbial contribution remains poorly estimated. Next-generation sequencing (NGS) techniques, including 16S rRNA gene profiling, are capable of rapid bacterial detection within clinical specimens. Nonunion cases may harbor microbes that escape detection by conventional culture methods that contribute to persistence. Our aim was to investigate the application of NGS pathogen detection to nonunion diagnosis.

Methods:

In this prospective multicenter study, samples were collected from 54 patients undergoing open surgical intervention for preexisting long-bone nonunion (n = 37) and control patients undergoing fixation of an acute fracture (n = 17). Intraoperative specimens were sent for dual culture and 16S rRNA gene-based microbial profiling. Patients were followed for evidence of fracture healing, whereas patients not healed at follow-up were considered persistent nonunion. Comparative analyses aimed to determine whether microbial NGS diagnostics could discriminate between nounions that healed during follow-up versus persistent nonunion.

Results:

Positive NGS detection was significantly correlated with persistent nonunion, positive in 77% more cases than traditional culture. Nonunion cases were observed to have significantly increased diversity and altered bacterial profiles from control cases.

Discussion:

NGS seems to be a useful adjunct in identification of organisms that may contribute to nonunion. Our findings suggest that the fracture-associated microbiome may be a significant risk factor for persistent nonunion. Ongoing work aims to determine the clinical implications of isolated organisms detected by sequencing and to identify robust microbial predictors of nonunion outcomes.

Level of Evidence:

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Mental Health Disorders and Suicidal Behaviors Among Provincial Correctional Workers
Authors: Ricciardelli Rosemary , McKendy Laura , Jamshidi Laleh , Carleton R. Nicholas
Published: January 2022

Objective

We examined the prevalence ofmental health disorders and suicidal behaviors (ideation, planning, and attempts) among a sample of provincial correctional workers in Manitoba.

Methods

Self-reported mental health data from a survey on correctional worker mental health and well-being were analyzed for 491 correctional workers.

Results

Over half (57%) of respondents screened positive for mental health disorder, most commonly major depressive disorder, and over one-third of respondents (37%) screened positive for more than one disorder. Positive mental health screens for all mental health disorders were associated with statistically significantly increased odds of lifetime suicidal ideation, and positive screens for most disorders were associated with past year suicidal ideation.

Conclusions

Relative to other public safety personnel and the general public, correctional workers appear have a higher prevalence of mental health disorders and suicidal behaviors. The association between positive screens for mental health disorders and suicidal behaviors highlights the vulnerability of correctional workers in regards to mental well-being.
The efficacy and safety of Chinese massage in the treatment of acute mastitis
Authors: Ren Longsheng , Zhang Jie , Guo Ruiying , Lyu Can , Zhao Danyang , Dong Zhihao , He Zenglin , Wang Qiang
Published: January 2022

Background:

The incidence of acute mastitis (AM) in lactating women has been increasing year by year. If there is no timely and appropriate treatment, AM may develop into mammary abscess and septicemia. This special situation has aroused social attention. Chinese massage has been widely used in the treatment of AM in recent years, but there is no systematic review of the effect of Chinese massage on AM. We plan to explore the efficacy and safety of Chinese massage in the treatment of AM.

Methods:

We will use a computer to search the following 8 electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data) on November 30, 2021. Randomized controlled trials (RCT) of Chinese massage therapy for AM were screened. Primary outcome measure: overall clinical response rate, breast pain score. Secondary outcome measures: milk secretion, temperature, mass size and time to resolution, White blood cell count, C-reactive protein, and the incidence of adverse reactions. According to the inclusion criteria and exclusion criteria, the included literature will be independently evaluated by two researchers using the RCT bias risk assessment tool in the Cochrane evaluation manual Handbook5.4, and meta-analysis will be performed by RevMan5.4 software. Funnel plots were used to analyze whether the study had publication bias.

Results:

We will evaluate the clinical effect of Chinese massage therapy on AM based on RCTs

Conclusion:

This study will provide evidence-based evidence for the effectiveness and safety of Chinese massage in the treatment of AM.

Protocol registration number:

INPLASY2021120019.
Anxiety faintly and depression remarkably correlate with recurrence in acute ischemic stroke patients
Authors: Luan Shaoqun , Wu Xin , Yin Shaohua
Published: January 2022

Clinical value of anxiety and depression in acute ischemic stroke (AIS) is rarely studied. Thus, the aim of this study was to explore longitudinal changes of anxiety and depression, as well as their correlation with recurrence in AIS.

A total of 120 AIS patients and 120 controls were enrolled in the study. Furthermore, comparison of the hospital anxiety and depression scale (HADS) score or rate between AIS and controls was determined by Mann–WhitneyUtest or Chi-square test. In AIS patients, change of HADS scores or linear trend of anxiety and depression rate over time were determined by Friedman test or Mantel-Haenszel Chi-square test. Moreover, correlation of anxiety and depression with the recurrence rate was analyzed by log-rank test.

HADS for anxiety score, anxiety rate, HADS for depression score and depression rate were all elevated in AIS patients compared with controls (allP < .001). In AIS patients, HADS for anxiety score was elevated from discharged from hospital (M0) to month (M) 36 (P = .027), while anxiety rate was not (P = .107). Besides, HADS-D score and rate were both increased from M0 to M36 (bothP < .001). Moreover, accumulating recurrence rate was 6.7%, 11.7%, and 17.5% at 1 year, 2 years, and 3 years, respectively. Additionally, anxiety at M24 (P = .033), depression at M0, M12, M24, and M36 (allP < .05) were all correlated with increased accumulating recurrence rate.

Continuous monitoring of anxiety and depression might be beneficial for the management of AIS prognosis.
Effectiveness and safety assessment of orthopedic device (LSM-01) for low back pain
Authors: Won Eun Sol , Lee Hyun , Kang Jae Hui
Published: January 2022

Background:

More than 80% of the population suffer from low back pain at some time during their lives. An orthopedic device (LSM-01) will be used to alleviate back pain caused by muscle tension. LSM-01, which has a rotating roller, stimulates meridian-muscles around the governor vessel, bladder meridian, and gall bladder meridian.

Methods:

This study will be a randomized, single-blinded, sham-controlled, parallel-group, pilot clinical trial. Subjects will be randomly allocated to the treatment group (LSM-01) or the control group (sham device). The duration of the clinical trial will be 2 weeks. The primary outcomes will be measured using the visual analog scale; the secondary outcomes will include pressure pain threshold, Oswestry Disability Index, and Patient Global Impression of Change. Statistical analysis will be performed for the full study population. Analysis of covariance will be conducted to identify differences in pain before and after the application of the device.

Discussion:

This clinical trial will evaluate the safety and efficacy of the LSM-01 device. As a pilot study, this investigation includes a limited number of subjects. The results of this pilot trial will form a basis for a large-scale clinical trial, which will be conducted in the future.

Clinical trial registration:

This study protocol is registered with the Clinical Research Information Service (CRIS) of Korea. Clinical trial registration number: CRIS-KCT0006425. Registered: October 5, 2021; https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=L&pageSize=10&page=undefined&seq=20056&status=5&seq_group=20056
Comparation of magnetic resonance hysterosalpingography and hysterosalpingosonography for the assessment of fallopian tubal occlusion of female infertility
Authors: Zhang Jili , Zhang Xiaopeng , Bian Jinyi , Wang Cong
Published: January 2022

Objective:

To evaluate the diagnostic performance of magnetic resonance hysterosalpingography (MR-HSG) for fallopian tubal occlusion in the context of female infertility when compared to the diagnostic performance of hysterosalpingosonography in evaluation of fallopian tubal occlusion of female infertility.

Methods:

We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the October 31, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.

Results:

This systematic review will investigate whether MR-HSG has more diagnostic value than hysterosalpingosonography in evaluation of fallopian tubal occlusion of female infertility.

Conclusion:

Our meta-analysis indicated MR-HSG may serve as an alternative for further evaluation of fallopian tubal occlusion of female infertility.

Systematic review registration:

INPLASY2021110050.
Nonsurgical spinal decompression system traction combined with electroacupuncture in the treatment of multi-segmental cervical disc herniation
Authors: Xu Qing , Tian Xuewen , Bao Xintong , Liu Dongren , Zeng Fanshuo , Sun Qiangsan
Published: January 2022

Rationale:

With the spread of computers and mobile phones, cervical spondylosis has become a common occupational disease in clinics, which seriously affects the quality of life of patients. We used a nonsurgical spinal decompression system (SDS) combined with physical therapy electroacupuncture (EA) to treat a case of mixed cervical spondylosis caused by multi-level cervical disc herniation, and we achieved satisfactory results.

Patient concerns:

A 44-year-old Caucasian Asian woman presented with neck pain and numbness on the left side of the limb. MRI showed the patient's C3–C7 segment cervical disc herniation, and the flexion arch of the cervical spine was reversed.

Diagnosis:

The patient was diagnosed with a mixed cervical spondylosis.

Interventions:

The patient received a month of physical therapy (SDS traction combined with EA).

Outcomes:

Before and after treatment: VAS score of neck pain decreased from 8 to 0; Cervical spine mobility returned to normal; The grip strength of left hand increased from 7.5 kg to 19.2 kg; Cervical curvature index changed from −16.04% to −3.50%; the physiological curvature of the cervical spine was significantly restored. There was no dizziness or neck discomfort at 6 month and 1 year follow-up.

Lessons subsetions:

SDS traction combined with EA is effective for the treatment of cervical disc herniation and can help restore and rebuild the biomechanical balance of the cervical spine.
Pneumatosis cystoides intestinalis
Authors: Zhang Qiuyu , Niu Xiangke , Wang Cong , He Qiang , Xiang Junying
Published: January 2022

Rationale:

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts in the intestinal wall, and can be caused by many conditions.

Patient concerns:

We reported a-69-year-old man with a long history of chronic obstructive pulmonary disease was admitted to the gastroenterology department because of alternating bowel movement and intermittent bloody stool.

Diagnoses:

Colonoscopy revealed multiple nodular protuberances covered with normal-looking mucosa in the ascending and proximal transverse colon. Abdominal computed tomography scan and endoscopic ultrasound revealed multiple gas-filled cystic lesions in the submucosa. The diagnosis of PCI was confirmed by cyst collapse after puncturing with a fine needle.

Interventions and outcomes:

Considering that the patient had no peritonitis or other complications, conservative approaches, including oxygen inhalation and oral probiotics, were used. The patient was transferred to the anorectal department after 5days of clinical observation in good condition to further treat hemorrhoids.

Lessons:

PCI is a rare condition that may be secondary to many other diseases. Because of its atypical clinical manifestations, it can be misdiagnosed as other diseases, such as polyps, inflammatory bowel disease, and even cancer. The diagnosis of PCI depends on computed tomography, colonoscopy, and endoscopic ultrasonography. Fine-needle aspiration may be helpful in the diagnosis and treatment of PCI.
Efficacy of EWINDOW for prevention of delirium at intensive care units
Authors: Liu Jijie , Wang Jie
Published: January 2022

Background:

Critically ill patients in intensive care units (ICUs) have restricted exposure to natural light throughout the day. As a result, they are more prone to undergo disruptions in circadian rhythmicity and sleep patterns, which may contribute to the development of delirium. As a measure to synchronize to the patterns of natural sunlight, EWINDOW has been proved to prevent delirium in some studies. Hence, the aim of this systematic review to evaluate the effectiveness of EWINDOW so as to prevent delirium.

Methods:

From January 2012 to December 2021, electronic databases such as China National Knowledge Infrastructure Database, Excerpta Medica database, PubMed, Cochrane Central Register of Controlled Trials, Wan Fang, and Cumulative Index of Nursing and Allied Health Literature are aimed to look for appropriate randomized controlled trials to evaluate the therapeutic impact of EWINDOW on delirium prevention. To be more exact, related studies are chosen, data is retrieved and the risk of bias is examined, then a meta-analysis is carried out in order.

Results:

The goal of this study is to show how effective EWINDOW is at preventing delirium in ICU. The incidence and duration of delirium are included in our outcome measures.

Conclusions:

This review evaluates related studies on the therapeutic effects of EWINDOW on the prevention of delirium in the ICUs.

Dissemination and ethics:

The findings of this study will be published in a peer-reviewed journal. As the study relies on publicly available data, no ethical approval is required. Furthermore, throughout the data analysis procedure, anonymity is protected.

OSF Registration: https://osf.io/NP3EW/
Comparison of D&C and hysteroscopy after UAE in the treatment of cesarean scar pregnancy
Authors: Cao Lili , Qian Zhida , Huang Lili
Published: January 2022

Cesarean scar pregnancy (CSP) stands for the severe complication secondary to cesarean section, and its incidence shows an increasing trend recently. However, no consensus has been reached about the CSP treatment. This study aims to explore the necessity of hysteroscopy (H/S) after preventive uterine artery embolization (UAE).

A case-control report. The childbearing CSP patients with a cesarean section history were evaluated by ultrasonography, with a gestational age of less than 10 weeks. Thirty-four patients receiving dilation and curettage (D&C) after UAE were enrolled into the D&C group, whereas 46 undergoing H/S and curettage after UAE were enrolled into the H/S group.

Differences in success rate and decrease in the β-hCG level in serum on the second day of surgery were not significantly different between D&C and H/S groups (P > .05). Also, differences in side effect rate (except for the anesthesia-related side effects), intraoperative blood loss amount, postoperative bleeding time, and total length of hospital stay were not significant between 2 groups (P > .05). Compared with D&C group, H/S group had decreased postoperative length of hospital stay (P < .05), increased hospitalization cost (P < .05), and significantly elevated time of CSP mass disappearance (P < .05). In addition, 8 (18.19%) patients in H/S group developed anesthesia-related side effects.

This study reveals no obvious difference between UAE + D&C and UAE + H/S in terms of the clinical efficacy and safety, except for the time of CSP mass disappearance and anesthesia-related side effects. The hospitalization cost is more expensive for UAE + H/S, but the postoperative length of stay is shorter for UAE + H/S. UAE + H/S is associated with the risk of anesthesia-associated side effects.
51Cr-EDTA plasma clearance in children
Authors: Pottel Hans , Goffin Karolien , De Waele Liesbeth , Levtchenko Elena , Delanaye Pierre
Published: January 2022

Plasma disappearance curves using multiple blood samples are a recognized reference method for measuring glomerular filtration rate (GFR). However, there is no consensus on the protocol for this type of measurement. A two-compartment model is generally considered acceptable for the mathematical description of the concentration–time decay curve. The impact of the fitting procedure on the reported GFR has not been questioned.

We defined 8 different fitting procedures to calculate the area under the curve, and from this area under the curve, the GFR. We applied the 8 fitting methods (all considering a full concentration–time curve) on the multiple sample data (8 samples) of 20 children diagnosed with Duchenne muscular dystrophy. We evaluated the effect (variability) on the reported GFR from the different fitting methods and compared these results with GFR-values calculated from late samples only (samples after 120 minutes) and from one-sample methods.

In 6 out of 20 cases, the fitting methods on the full concentration–time curve resulted in very different reported GFR-values, mainly because some methods were not able to fit the data, or methods resulted in GFR-values ranging from 0 to 120 mL/min. The reported GFR-result therefore strongly depends on the fitting method, making the full concentration–time method less robust than expected. Compared with a consensus reference GFR, the late sample models did not show fitting issues and may therefore be considered as more robust. Also the one-sample methods showed acceptable accuracy.

The late sample methods (using 3 time-points) provide robust and reliable methods to determine GFR.
A case report of a patient with inoperable primary diffuse leptomeningeal melanomatosis treated with whole-brain radiotherapy and pembrolizumab
Authors: Palacka Patrik , Slopovsky Jan , Makovnik Marek , Kajo Karol , Obertova Jana , Mego Michal
Published: January 2022

Rationale:

Primary diffuse leptomeningeal melanomatosis (PDLM) is a rare disease that affects melanocytes in the leptomeninges. There is very limited data on the efficacy of immunotherapy in this setting.

Patient concerns:

A patient (23 years old) was diagnosed with PDLM. Histologically, atypical melanocytic cells were also observed.

Diagnosis:

Immunohistochemistry showed positivity for S100 protein, NKiC3, and vimentin, and negativity for Melan-A and HMB-45, with a proliferation index of 30%. Extracranial disease was excluded using dermatological and other examinations, including positron emission tomography/computed tomography with
18
F-fluorodeoxyglucose.

Interventions:

The patient was treated with whole-brain radiotherapy (10 fractions to a total dose of 30 Gy) concomitantly with pembrolizumab and then continued with immunotherapy until disease progression with a maximum effect of partial remission on magnetic resonance imaging scans.

Outcomes:

Progression-free survival was 6.0 months and overall survival 6.5 months.

Lessons:

This is one of the few case reports of an adult patient with this rare malignancy being treated with a programmed death-1 inhibitor with partial response. Immunotherapy in metastatic PDLM may be a reasonable therapeutic option.
The most influential articles on kidney transplantation
Authors: Jun Heungman , Hwang Ji Woong
Published: January 2022

Background:

Kidney transplantation (KT) has become common in the treatment of end-stage renal disease. However, to date, there have been no bibliometric analyses of KT research to identify the most influential articles. The purpose of this research is to identify and characterize the 100 most cited articles that focus on KT and to clarify the trends in the accomplishments in this field.

Methods:

We searched the Thomson Reuters Web of Science citation indexing database and used keyword mapping of VOSviewer. The top 100 most cited manuscripts were analyzed based on their titles, authors, institutions, countries of origin, years of publication, and topics.

Results:

The New England Journal of Medicine has published the most manuscripts on kidney transplantation (n = 26) and is the most cited journal (n = 15,642). The United States has the highest number of publications (n = 61). Kashika is the corresponding author with the most published papers (n = 5; 2892 citations). The most common topics of publication are immunosuppressant (n = 34), clinical outcome (n = 26), and pathology (n = 22). Keywords related to immunosuppressant are the most common in keyword mapping with VOSviewer.

Conclusions:

This bibliometric analysis of KT research provides the research characteristics and publication trends of this topic. In KT research, immunosuppressants and post-transplant clinical outcomes have been important topics.
Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension
Authors: Zhang Song , Wang Tianxun , Wang Huaiqi , Tang Jianping , Hou Ailin , Yan Xiaoling , Yu Baozhong , Ran Shuangming , Luo Min , Tang Ying , Yang Ruohan , Song Dongsheng , He Hanjun
Published: January 2022

Background:

Hypertension and hyperhomocysteinemia (HHcy) have long been associated with adverse cardiovascular and cerebrovascular health outcomes. This study evaluated the effect of individualized administration of folic acid (FA) on homocysteine (Hcy) levels, prothrombotic state, and blood pressure (BP) in patients with H-type hypertension (combination of HHcy and hypertension).

Methods:

In this double-blinded, randomized clinical cohort study, 126 patients with H-type hypertension who were treated at our hospital were randomly divided into treatment and control groups (n = 55 each). The control group was treated with oral levamlodipine besylate tablets 2.5 mg and placebo, once a day (in the morning). The treatment group was first treated with oral levamlodipine besylate 2.5 mg and FA tablets 0.8 mg, once a day (in the morning), for 12 weeks. Then, in a second 12-week phase, the FA dose was adjusted using the methylene tetrahydrofolate reductase C677 polymorphism genotype. The levels of Hcy and coagulation factors, prothrombotic state parameters, BP, and adverse drug reactions were compared between the 2 groups.

Results:

Pretreatment general patient characteristics, including Hcy levels, were similar between the 2 groups (P > .05). BP and prothrombotic status did not differ before and after the first phase of treatment (P > .05). However, Hcy and endothelin-1 (ET-1) levels decreased, while nitric oxide levels increased significantly in the intervention group (P < .05). In the second phase, after 3 months’ treatment with an FA dose adjusted according to methylene tetrahydrofolate reductase C677T genotype, the Hcy and ET-1/NO levels were significantly decreased in the intervention group and were lower than those after the first treatment phase and lower than in the control group (P < .01). BP, D-dimer levels, and fibrinogen scores were significantly lower after the second treatment phase (P < .01). There was no significant difference in the incidence of adverse drug reactions between the 2 groups (P > .05).

Conclusions:

Individualized administration of FA tablets can effectively reduce BP, and Hcy and coagulation factor levels, and significantly improve prothrombotic status in patients with H-type hypertension.
Astragalus membranaceus (Huang Qi) for cancer-related fatigue
Authors: Dong Jun , Wang Shuo , Gui Yuerong , Wang Dandan , Ma Xiumei , Hu Shuaihang , Wang Xinyan , Zhang Ying , Hou Wei
Published: January 2022

Background:

Cancer-related fatigue (CRF) is one of the most common complications of cancer. The incidence of CRF is higher than 80%. The NCCN describes it as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion. It exists in cancer treatment and may last for months or even years. CRF seriously impairs patients’ quality of life. However, there is still a lack of effective drug treatment. Astragalus can improve patients’ fatigue state in the clinical practice of Chinese medicine. There are some studies on the treatment of CRF with Astragalus-containing prescription. However, there is no comprehensive analysis of them. We will perform a meta-analyze on the therapeutic effect of Astragalus-containing prescription for CRF.

Methods:

We will search China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang Database, EMBASE, MEDLINE, and the Cochrane Registry of Controlled Clinical Trials. The information is from the databases’ inception to December 15, 2021. According to the Cochrane Handbook for Systematic Reviews of Interventions, data extraction and processing are carried out. Review Manager 5.4 is used for meta-analysis.

Results:

We will take the severity of CRF as the primary outcome.

Conclusions:

We will conduct a meta-analysis to evaluate the efficacy of Astragalus-containing prescriptions in treating CRF.
Peripapillary hyper-reflective ovoid mass-like structure and dome-shaped maculopathy
Authors: Zhang Wei , Bi Da-Guang , Peng Xiao-Yan , Gu Wei
Published: January 2022

Rationale:

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) and dome-shaped macula (DSM) are 2 optical coherence tomography findings reported in 2018 and 2008, respectively. To date, there have been no ophthalmic case reports of concomitant PHOMS and DSM.

Patient concerns:

A 19-year-old woman presented to our clinic with complaints of decreased vision in both eyes.

Diagnosis:

The patient was diagnosed with PHOMS and a dome-shaped macula complicated by subretinal fluid in both eyes.

Interventions:

A micropulse laser under the guidance of Indocyanine green angiography was applied to the hyperfluorescent areas and drugs to improve retinal microcirculation.

Outcomes:

No response to any intervention over the 41 months of follow-up, her visual acuity remained the same, and the subretinal fluid often recurred.

Lessons:

PHOMS and DSM are associated with myopia; myopia may be a mediator between PHOMS and DSM. Dome-like structural changes may occur in different parts of the retina (optic disc and macula), caused by asymmetric myopic posterior scleral growth.
Hemangioblastoma masquerading as a ring enhancing lesion in the cerebellum
Authors: Li Li , Xie Hui-Min , Richard Seidu A. , Lan Zhigang
Published: January 2022

Rationale:

Hemangioblastomas (HGBMs) are very rare, and the cerebellum is usually the most common site of occurrence. HGBMs with ring-enhanced walls are often misdiagnosed as metastases, abscesses, glioblastomas, tuberculomas, and demyelinating diseases. Thus, we present a rare case of HGBM masquerading as a ring-enhancing lesion in the cerebellum.

Patient concerns:

We present a 33-year-old female who was admitted to our department because of headaches, unstable walking, and visual loss in both eyes. Cranial nerve examination revealed deficits in cranial nerve II.

Diagnosis:

Magnetic resonance imaging revealed 2 cystic lesions in the cerebellum, with irregular ring-enhanced cyst walls composed of smaller nodular parts. Immunohistochemical staining of resected specimens established HGBM.

Interventions:

The lesions were completely resected using a right retrosigmoid approach.

Outcomes:

Two years of follow-up revealed no recurrence of her symptoms or tumor. She is currently well and performs her daily duties.

Lessons:

HGBMs with enhanced cysts are often misdiagnosed by radiology because of their ring-enhanced nature. Computed tomography angiography may be the best modality for differentiating cerebellar HGBM from other ring-enhancing lesions. Surgery is the gold standard of treatment for these lesions.
Reducing PICU-to-Floor Time-to-Transfer Decision in Critically Ill Bronchiolitis Patients using Quality Improvement Methodology
Authors: Fritz Cristin Q. , Martin Blake , Riccolo Megan , Fennell Michelle , Rolison Elise , Carpenter Todd , Bajaj Lalit , Tyler Amy , Brittan Mark
Published: January 2022

Introduction:

Specific criteria for de-escalation from the PICU are often not included in viral bronchiolitis institutional pathways. Variability of transfer preferences can prolong PICU length of stay. We aimed to decrease the time from reaching floor-appropriate heated high flow nasal cannula (HHF) settings to the transfer decision by 20% through standardizing PICU-to-floor transfer assessment in a PICU bronchiolitis cohort.

Methods:

We included PICU bronchiolitis admissions from October 2019 to April 2020, who were 6-months to 2-years-old with no comorbidities nor intubation during their encounter. Our intervention bundle included introduction of transfer criteria and standardization of transfer-readiness assessment. The primary outcome was time from reaching floor-appropriate HHF settings [8 L per minutes (Lpm)] to placement of the transfer order (“time-to-transfer decision”). The secondary outcome was PICU length of stay. The main process measure was the proportion of patients transferred on ≥6 Lpm HHF. Balancing measures included Rapid Response Team activation and unplanned PICU readmission. We assessed admissions meeting inclusion criteria from December, 2018-March, 2019 for the preintervention baseline.

Results:

Special cause variation indicated improvement in our primary outcome and process measures. Comparison of baseline to postintervention revealed a reduction in median time-to-transfer decision (14.4–7.8 hours; P < 0.001) and increase in children transferred on ≥6 Lpm (51%–72%; P < 0.001). We observed no change in PICU length of stay or balancing measures.

Conclusion:

Standardizing de-escalation criteria and transfer-readiness assessment reduced the time-to-transfer decision out of the PICU and increased the proportion transferred on ≥6 Lpm HHF for children with viral bronchiolitis without increasing PICU readmissions.