bluuebunny/crossref_metadata_2025 huggingface dataset:
Meniscal Allograft Transplantation
Authors: Yow Bobby G. , Donohue Michael , Tennent David J.
Published: August 2021

Meniscal allograft transplantation provides treatment options for patients with a meniscus-deficient knee with lifestyle-limiting symptoms in the absence of advanced degenerative changes. Meniscal transplantation helps to restore the native biomechanics of the involved knee, which may provide chondroprotective effects and restoring additional knee stability. Improvements in pain, function, and activity level have been seen in appropriately selected patients undergoing transplantation. Although various surgical implantation options exist, the majority focus on reproducing native attachments of the meniscal roots to allow near normal mechanics. Although meniscal transplantation may serve as a salvage procedure for symptomatic patients with a meniscus-deficient knee, it may prevent or delay the necessity of a more invasive arthroplasty procedure.
Rehabilitation and Return to Play Following Meniscus Repair
Authors: Wedge Christopher , Crowell Michael , Mason John , Pitt William
Published: August 2021

Injuries to the meniscus, particularly tears, can have significant negative impacts on pain, function, and quality of life. Preservation of the meniscus is favorable, especially in the athletic and active populations. While first line treatment is often nonoperative in nature, recalcitrant, and more complex tears, typically require surgery. Meniscus repair rates have increased significantly during the last 2 decades as surgical techniques and postoperative outcomes have improved. Longer postoperative timeframes are to be expected when compared with menisectomy, however, accelerated programs have demonstrated favorable outcomes. Rehabilitation and return to play guidelines should reflect the intricacies of the tear type and repair procedure. Close communication with the surgeon is a vital component to optimize patient outcomes. Further, the patient’s goals and expected level of return to function, or sport, must be taken into account for a rehabilitation program to be fully successful.
Moderate-intensity exercise with blood flow restriction on cardiopulmonary kinetics and efficiency during a subsequent high-intensity exercise in young women
Authors: Borges Robson F. , Chiappa Gaspar R. , Muller Paulo T. , de Lima Alexandra Correa Gervazoni Balbuena , Cahalin Lawrence Patrick , Cipriano Graziella França Bernardelli , Cipriano Gerson
Published: August 2021

Blood flow restriction (BFR) training applied prior to a subsequent exercise has been used as a method to induce changes in oxygen uptake pulmonary kinetics (

O2P) and exercise performance. However, the effects of a moderate-intensity training associated with BFR on a subsequent high-intensity exercise on

O2P and cardiac output (QT) kinetics, exercise tolerance, and efficiency remain unknown.

This prospective physiologic study was performed at the Exercise Physiology Lab, University of Brasilia. Ten healthy females (mean ± SD values: age = 21.3 ± 2.2 years; height = 1.6 ± 0.07 m, and weight = 55.6 ± 8.8 kg) underwent moderate-intensity training associated with or without BFR for 6 minutes prior to a maximal high-intensity exercise bout.

O2P, heart rate, and QT kinetics and gross efficiency were obtained during the high-intensity constant workload exercise test.

No differences were observed in

O2P, heart rate, and QT kinetics in the subsequent high-intensity exercise following BFR training. However, exercise tolerance and gross efficiency were significantly greater after BFR (220 ± 45 vs 136 ± 30 seconds; P < .05, and 32.8 ± 6.3 vs 27.1 ± 5.4%; P < .05, respectively), which also resulted in lower oxygen cost (1382 ± 227 vs 1695 ± 305 mL min–1).

We concluded that moderate-intensity BFR training implemented prior to a high-intensity protocol did not accelerate subsequent

O2P and QT kinetics, but it has the potential to improve both exercise tolerance and work efficiency at high workloads.
Dramatic response to osimertinib combined with crizotinib in EGFR T790 M mutation only in blood and Met amplification only in tumor tissue expressive non-small cell lung cancer
Authors: Li Dapeng , Gui Qi , Xu Caihua , Shen Meng , Chen Kai
Published: August 2021

Rationale:

Besides the T790 M mutation, it may coexist with bypass pathway activation in real clinical cases for patients with EGFR mutations who resisted to the first- and second-generation tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). There are limited clinical trial data describing the efficacy of osimertinib combined with MET inhibition in EGFR T790M-mutant NSCLC patients with Met amplification.

Patient concerns:

A non-smoking 53-year-old male patient with lung adenocarcinoma underwent gefitinib, afatinib, and osimertinib combined with crizotinib treatment and developed different EGFR resistance mutations.

Diagnoses:

The patient was diagnosed with lung adenocarcinoma (stage cT4N2M0, IIIB). After resistance to the therapy targeting EGFR exon 21 L858R point mutation, T790 M mutation was detected in liquid biopsy and Met amplification was detected via tissue biopsy by next-generation sequencing (NGS).

Interventions:

The patient received systemic treatments, including chemotherapy, gefitinib, afatinib, and osimertinib combined with crizotinib.

Outcomes:

The patient died of multisystem organ failure and had an overall survival of 24 months.

Lessons:

Although osimertinib combined with crizotinib therapy showed dramatic tumor shrinkage in both the primary tumor and bone metastasis to an EGFR T790M-mutant NSCLC patient with MET amplification, the progression-free survival (PFS) was only two months.
Clinical therapeutic effects of opioid analgesia for acute abdominal pain in children and young adults
Authors: Li Jie , Hu Fei-Yan , Zhong Guo
Published: August 2021

Background:

Nearly 10% of all patients who visit the emergency department report severe abdominal pain. Out of these, almost one-third are not diagnosed accurately. The conventional practice to care for such inpatients involves actively managed observation and repetitive clinical assessments at regular intervals. The aim of this study is to assess the clinical therapeutic effects of opioid analgesia in the treatment of severe abdominal pain in kids and adolescents.

Methods:

A comprehensive electronic search will be done on Web of Science, EMBASE, PubMed, WanFang database, Chinese National Knowledge Infrastructure, and the Cochrane Library from their establishment to May 2021. The search will identify and retrieve all randomized controlled trials that describe the clinical therapeutic effects of opioid analgesia to treat severe abdominal pain in adolescents and children. Two independent authors will shortlist studies that meet the inclusion criteria, extract data from selected studies, and evaluate the risk associated with bias in the selected articles. We will use RevMan (v: 5.3) to conduct all the data synthesis.

Results:

This meta-analysis will conduct a high-quality synthesis on present evidence related to the usage of opioid analgesia to treat severe abdominal pain in both kids and adolescents.

Conclusion:

Our findings will summarize the present evidence and help judge whether opioid analgesia is an effective and safe line of treatment for severe abdominal pain.

Ethics and dissemination:

This study will use pre-published data, and as such, it does not require ethics approval.

OSF registration number:

May 29, 2021.osf.io/fp9ym (https://osf.io/fp9ym/).
Integrated bioinformatics analysis reveals CDK1 and PLK1 as potential therapeutic targets of lung adenocarcinoma
Authors: Li Shuzhen , Li Hua , Cao Yajie , Geng Haiying , Ren Fu , Li Keyan , Dai Chunmei , Li Ning
Published: August 2021

This study is to identify potential biomarkers and therapeutic targets for lung adenocarcinoma (LUAD).

GSE6044 and GSE118370 raw data from the Gene Expression Omnibus database were normalized with Robust Multichip Average. After merging these two datasets, the combat function of sva packages was used to eliminate batch effects. Then, limma packages were used to filtrate differentially expressed genes. We constructed protein–protein interaction relationships using STRING database and hub genes were identified based on connectivity degrees. The cBioportal database was used to explore the alterations of the hub genes. The promoter methylation of cyclin dependent kinase 1 (CDK1) and polo-like Kinase 1 (PLK1) and their association with tumor immune infiltration in patients with LUAD were investigated using DiseaseMeth version 2.0 and TIMER databases. The Cancer Genome Atlas-LUAD dataset was used to perform gene set enrichment analysis.

We identified 10 hub genes, which were upregulated in LUAD, among which 8 were successfully verified in the Cancer Genome Atlas and Oncomine databases. Kaplan–Meier analysis indicated that the expressions of CDK1 and PLK1 in LUAD patients were associated with overall survival and disease-free survival. The methylation levels in the promoter regions of these 2 genes in LUAD patients were lower than those in normal lung tissues. Their expressions in LUAD were associated with tumor stages and relative abundance of tumor infiltrating immune cells, such as B cells, CD4+ T cells, and macrophages. Moreover, cell cycle, DNA replication, homologous recombination, mismatch repair, P53 signaling pathway, and small cell lung cancer signaling were significantly enriched in CDK1 and PLK1 high expression phenotype.

CDK1 and PLK1 may be used as potential biomarkers and therapeutic targets for LUAD.
The characteristics and influencing factors of fever in postoperative patients undergoing percutaneous nephrolithotomy
Authors: Yu Ying , Pu Jieyu , Wu Tingting , Hu Li
Published: August 2021

Percutaneous nephrolithotomy (PCNL) is commonly used for the treatment of upper urinary calculi in clinical setting, and fever is a common complication after PCNL. It is necessary to evaluate the risk factors of fever in patients undergoing PCNL, to provide insights into the management of PCNL.

Patients who underwent PCNL in our hospital from January 2018 to August 2020 were included. The clinical data of postoperative fever and no fever patients were collected and assessed. Logistic regression analyses were conducted to analyze the risk factors for fever in patients undergoing PCNL.

A total of 276 patients undergoing PCNL were included, the incidence of postoperative fever for patients undergoing PCNL was 19.39%. No significant differences in the gender, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, intraoperative blood infusion, length of hospital stay between fever patients, and no fever patients were found (all P > .05). There were significant differences in the age, diabetes, size of stones, duration of surgery between fever patients, and no fever patients (all P < .05). Age ≥60 years (odds ratio [OR] 2.143, 95% confidence interval [CI] 1.101∼3.264), diabetes (OR 2.218, 95% CI 1.176∼4.642), size of stone ≥2 cm (OR 1.428, 95%CI 1.104∼2.055), duration of surgery ≥100 minutes (OR 1.334, 95% CI 1.015∼1.923) were the risk factors for fever in patients with PCNL (all P < .05). Escherichia coli (48.44%), Staphylococcus aureus (18.75%), and Candida albicans (10.93%) were the top 3 pathogenic bacteria of urine culture.

Fever is one of the common complications after PCNL. Patients with high-risk factors should be given full attentions and take corresponding preventive measures targeted on risks.
Evaluation of pain susceptibility by taking blood pressure in patients with infections
Authors: Eldin Carole , Boudjema Sophia , Meddeb Line , Boyer Laurent , Soriano Christophe , Parola Philippe , Lagier Jean-Christophe , Stein Andreas , Gouriet Frédérique , Gautret Philippe , Million Matthieu , Raoult Didier
Published: August 2021

Pain sensitization leading to polyalgia can be observed during infectious diseases. The blood pressure cuff-evoked pain threshold (BPCEPT) has been used in previous studies as a screening tool for fibromyalgia.

We aimed to use the BPCEPT as a screening test for detecting pain sensitization in patients suffering from infectious diseases. We also investigated whether specific factors were associated with pain sensitization.

We performed a prospective comparative study including all patients of our infectious diseases center in a 1-year period. We created a positive control group of patients suffering from fibromyalgia and a negative control group of “apparently healthy” patients consulting for vaccination.

The blood pressure (BP) cuff was inflated until the patient signaled that they experienced pain, and this pressure value was noted.

A total of 2355 patients were included. The positive control group had significantly lower values of the BPCEPT than all other groups. Among hospitalized patients with infectious diseases, a low BPCEPT was significantly associated with high temperature (P < .0001), older age (P = .002), being a woman (P = .004), high serum glutamic-oxaloacetic transaminase (P = .007), and high C reactive protein levels (P = .02). Moreover, in multivariate analysis, respiratory infection, meningitis, urinary tract infection, febrile neutropenia, and Q fever were independently associated with a low BPCEPT. A significant negative dynamic correlation between the BPCEPT and temperature was also observed (P < .001).

We demonstrated for the first time in a large sample of patients that the BPCEPT method can be used to detect pain susceptibility. We observed a significant dynamic correlation between pain sensitization and temperature. Additionally, pain sensitization was associated with some diseases, suggesting that they trigger pain sensitivity.
The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome
Authors: Li Xiaocui , Liu Xinru , Zuo Yan , Gao Jiejun , Liu Yan , Zheng Wei
Published: August 2021

The influencing factors of gestational diabetes mellitus (GDM) in the polycystic ovary syndrome (PCOS) patients remain unclear, we aimed to investigate the risk factors of GDM in patients with PCOS, to provide reliable evidence for the prevention and treatment of GDM in PCOS patients.

PCOS patients treated in our hospital from January 1, 2019 to October 31, 2020 were included. The personal and clinical treatment details of GDM and no GDM patients were analyzed. Logistic regressions were performed to analyze the factors influencing the occurrence of GDM.

A total of 196 PCOS patients were included, the incidence of GDM in patients with PCOS was 23.98%. There were significant differences in the age, body mass index, insulin resistance index, fasting insulin, testosterone, androstenedione, and sex hormone-binding protein between GDM and no GDM patients with PCOS (all P < .05), and no significant differences in the family history of GDM, the history of adverse pregnancy, and multiple pregnancies were found (all P > .05). Age ≥30 years (odds ratio (OR) 2.418, 95% confidence interval (CI) 1.181–3.784), body mass index ≥24 kg/m2 (OR 1.973, 95%CI 1.266–3.121), insulin resistance index ≥22.69 (OR 2.491, 95%CI 1.193–4.043), fasting insulin ≥22.71 mIU/L (OR 2.508, 95%CI 1.166–5.057), testosterone ≥2.85 nmol/L (OR 1.821, 95%CI 1.104–2.762), androstenedione ≥6.63 nmol/L (OR 1.954, 95%CI 1.262–2.844), sex hormone-binding protein <64.22 nmol/L (OR 1.497, 95%CI 1.028–2.016) were the independent risk factors of GDM in patients with PCOS (all P < .05). The incidence of preeclampsia, premature delivery, premature rupture of membranes, polyhydramnios, and postpartum hemorrhage in the GDM group was significantly higher than that of the no-GDM group (all P < .05). There was no significant difference in the incidence of oligohydramnios between the 2 groups (P = .057).

The incidence of GDM in PCOS patients is high, and the measures targeted at the risk factors are needed to reduce the occurrence of GDM in patients with PCOS.
Overexpression of MMP14 predicts the poor prognosis in gastric cancer
Authors: Wang Xikai , Meng Qinghe , Wang Yuanyuan , Gao Yanlu
Published: August 2021

Background:

Plenty of studies have showed matrix metalloproteinase 14 (MMP14) expression might be associated with the prognosis of gastric cancer (GC). However, no definite conclusion has been obtained for the contradictory results.

Methods:

We searched PubMed, Web of science, Embase, and Cochrane library for eligible studies. The association between MMP14 expression and prognostic outcomes of GC was evaluated. Hazard ratio (HR) and 95% confidence interval (CI) were integrated to show the effect of MMP14 expression on the overall survival (OS) or recurrence-free survival (RFS). Data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) was used to validate the association of MMP14 expression with OS or RFS in GC. A brief bioinformatics analysis was also performed to determine the prognostic role of MMP14 expression in GC.

Results:

High MMP14 expression was associated with shorter OS compared to low MMP14 expression in GC (HR = 1.95, P < .01). Patients with high MMP14 expression tended to have worse differentiation (P = .03), deeper tumor invasion (P < .01), earlier lymph node metastasis (P < .01), earlier distant metastasis (P < .01) and more advanced clinical stage (P < .01) compared to those with low MMP14 expression. The data from TCGA and GEO showed MMP14 was overexpressed in tumor tissues compared to normal tissues (P < .05), and high MMP14 expression was significantly related to shorter OS (HR = 1.70, 95% CI = 1.32–2.20, P < .01) and RFS (HR = 1.45, 95% CI = 1.15–1.83, P < .01) compared to low MMP14 expression in GC. Expression of MMP14 was linked to functional networks involving the biological process, metabolic process, response to stimulus, cell communication and so on. Functional network analysis suggested that MMP14 regulated the protein digestion and absorption, extracellular matrix receptor interaction, focal adhesion, ribosome, spliceosome, and so on.

Conclusion:

High MMP14 expression was associated with worse prognosis of GC compared to low MMP14 expression. MMP14 expression could serve as a prognostic factor and potential therapeutic target of GC.
Changes of trabecular meshwork pigmentation in patients with pigment dispersion syndrome
Authors: Zhou Rongyao , Tang Qi , Pu Liping , Qing Guoping
Published: August 2021

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block.

Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline.

Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 ± 6.93 years (range, 31–55 years) at initial diagnosis. The mean IOP level was 33.1 ± 9.8 mmHg (range, 22–56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15–16) on admission, which changed to 14 (IQR, 13–15), 13 (IQR, 12–14), 12(IQR, 10.5–12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 ± 3.4 mmHg.

TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.
Comprehensive analyses of potential key genes in active tuberculosis
Authors: Chen Jiarui , Liu Chong , Liang Tuo , Xu Guoyong , Zhang Zide , Lu Zhaojun , Jiang Jie , Chen Tianyou , Li Hao , Huang Shengsheng , Chen Liyi , Sun Xihua , Cen Jiemei , Zhan Xinli
Published: August 2021

Background:

Tuberculosis (TB) is a global health problem that brings us numerous difficulties. Diverse genetic factors play a significant role in the progress of TB disease. However, still no key genes for TB susceptibility have been reported. This study aimed to identify the key genes of TB through comprehensive bioinformatics analysis.

Methods:

The series microarray datasets from the gene expression omnibus (GEO) database were analyzed. We used the online tool GEO2R to filtrate differentially expressed genes (DEGs) between TB and health control. Database for annotation can complete gene ontology function analysis as well as Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Protein-protein interaction (PPI) networks of DEGs were established by STRING online tool and visualized by Cytoscape software. Molecular Complex Detection can complete the analysis of modules in the PPI networks. Finally, the significant hub genes were confirmed by plug-in Genemania of Cytoscape, and verified by the verification cohort and protein test.

Results:

There are a total of 143 genes were confirmed as DEGs, containing 48 up-regulated genes and 50 down-regulated genes. The gene ontology and Kyoto Encyclopedia of Genes and Genomes analysis show that upregulated DEGs were associated with cancer and phylogenetic, whereas downregulated DEGs mainly concentrate on inflammatory immunity. PPI networks show that signal transducer and activator of transcription 1 (STAT1), guanylate binding protein 5 (GBP5), 2′-5′-oligoadenylate synthetase 1 (OAS1), catenin beta 1 (CTNNB1), and guanylate binding protein 1 (GBP1) were identified as significantly different hub genes.

Conclusion:

We conclude that these genes, including TAT1, GBP5, OAS1, CTNNB1, GBP1 are a candidate as potential core genes in TB and treatment of TB in the future.
Early steroid pulse therapy for children with suspected acute encephalopathy
Authors: Ishida Yusuke , Nishiyama Masahiro , Yamaguchi Hiroshi , Tomioka Kazumi , Takeda Hiroki , Tokumoto Shoichi , Toyoshima Daisaku , Maruyama Azusa , Seino Yusuke , Aoki Kazunori , Nozu Kandai , Kurosawa Hiroshi , Tanaka Ryojiro , Iijima Kazumoto , Nagase Hiroaki
Published: August 2021

Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We sought to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels.

We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature >38°C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at 6 hours from onset, and AST elevation >90 IU/L within 6 hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1-2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy.

Fifteen patients with acute encephalopathy and 5 patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, P = .405). Even after excluding 2 patients with brainstem lesions, no significant correlation between PCPC and steroid pulse therapy timing (rs = 0.583, P = .060) was noted. However, the prognosis tended to be better in patients who received steroid pulse therapy earlier.

Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with elevated AST. Still, even earlier administration of treatment could prevent the possible neurological sequelae of this condition.
Effectiveness and safety of different traditional Chinese medicines for Coronavirus disease 2019
Authors: Huang Bo , Liu Yingfeng , Pi Chiheng , Yan Shifan , Li Fusheng
Published: August 2021

Introduction:

The effectiveness of different Traditional Chinese Medicine in the treatment of COVID-19 is worthy of attention, but the efficacy and safety of different Traditional Chinese Medicine in the treatment of COVID-19 have not yet been compared, based on network meta-analysis.

Methods and analysis:

The 2 members independently searched 7 databases according to the retrieval strategy, and the retrieval time was from the beginning of the establishment of the database to June 19, 2021. Then the title was imported into the EndNote Software AQ8 (V.X9), and the duplicate literature was deleted successively, the nonconforming articles were deleted in the title reading, and finally the full text was read to determine the articles included in the study. The Cochrane Collaboration's Tool will be used to evaluate the article quality, and Stata Statistical Software (Version 14.0, Stata Corporation, College Station, TX) will be used for data analysis. Levels of evidence are evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument.

Results:

The efficacy and safety of different Traditional Chinese Medicine in the treatment of COVID-19 were evaluated, and the order was determined according to the value of sucre.

Conclusion:

This study will provide evidence for the treatment of COVID-19 with TCM therapy, and provide ideas for the clinical treatment of COVID-19.

INPLASY registration number:

No. INPLASY202160092.
Improving motor and cognitive recovery following severe traumatic brain injury using advanced emotional audio-video stimulation
Authors: De Luca Rosaria , Pollicino Patrizia , Rifici Carmela , de Cola Cristina , Billeri Luana , Marino Silvia , Trifirò Simona , Fiumara Elisabeth , Randazzo Maria , Bramanti Placido , Torrisi Michele
Published: August 2021

Rationale:

It is estimated that about 6 million people suffer from severe traumatic brain injury (TBI) each year (73 cases per 100,000 people). TBI may affect emotional, sensory-motor, cognitive, and psychological functions with a consequent worsening of both patient and his/her caregiver's quality of life. In recent years, technological innovations allowed the development of new, advanced sensory stimulation systems, such as Neurowave, to further stimulate residual cognitive abilities and, at the same time, evaluate residual cognition.

Patient concern:

An 69-year-old Italian man entered our neurorehabilitation unit with a diagnosis of minimally conscious state following severe TBI. He breathed spontaneously via tracheostomy and was fed via percutaneous gastrostomy. At the neurological examination, the patient showed severe tetraparesis as he showed fluctuating alertness and responsiveness to external stimuli and opened the eyes without stimulation.

Diagnosis:

Patient was affected by subarachnoid hemorrhage and frontotemporal bilateral hematoma, which were surgically treated with decompressive craniotomy and subsequent cranioplasty about 6 months before.

Interventions:

The patient underwent a neuropsychological and clinical evaluation before (T0) and after a conventional rehabilitation cycle (T1), and after a Neurowave emotional stimulation-supported rehabilitative cycle (T2).

Outcomes:

Following conventional rehabilitation (T1), the patient achieved a partial improvement in behavioral responsiveness; there was also a mild improvement in the caregiver's distress. Conversely, Neurowave emotional stimulation session determined (at T2) a significant improvement of the patient's behavioral responsiveness, cognition, and in the caregiver's distress. The P300 recording in response to the NES showed a significant change of P300 magnitude and latency.

Discussion:

Our data suggest that emotional-integrated sensory stimulation using adequate visual stimuli represents a beneficial, complementary rehabilitative treatment for patients in minimally conscious state following a severe TBI. This may occur because stimuli with emotional salience can provide a reliable motivational resource to stimulate motor and cognitive recovery following severe TBI.
Cardiac anomalies associated with Escobar syndrome
Authors: ALGhasab Naif Saad , Alshehri Bandar , Altamimi Leen Abdullah , Assiri Raghad Asaad , AlYousef Loujain Ahmad , ALMesned Sulaman , ALreshidi Fayez Saud , Kharabsheh Suleiman M. , Al-Saud Sara Abou , Alharbi Waleed
Published: August 2021

Rationale:

Escobar syndrome (ES) is an autosomal recessive disorder. It is highly characterized by facial abnormalities, congenital diaphragmatic muscle weakness, myasthenic-like features, and skin pterygiums on multiple body legions. ES is a rare condition associated with many external and internal abnormalities. The internal malformations described in ES affect many organs including the heart, lungs, esophagus, liver, spleen, and intestine. The purpose of this paper is to explore the cardiac manifestations associated with ES.

Patient concerns:

A 3.5-year-old girl, who was born for double first cousins, was admitted to the hospital for neuromuscular evaluation of multiple congenital contractures.

Diagnosis:

The girl was diagnosed with ES and isolated dextrocardia which is a rare cardiac manifestation. However, to the best of our knowledge, no similar cases have been reported to date, and this case is thus believed to be very rare.

Interventions:

The patient underwent an operative intervention to correct the bilateral fixed flexion deformity at her knees which was related to the posterior bilateral fibrotic bands/pterygia.

Outcomes:

Post-operatively, complete knee extension was obtained, the patient was fitted with a cast and extension night splint. She was discharged alive and had no complications. The patient was followed regularly in the orthopedic clinic and had periodic physiotherapy sessions.

Conclusions:

ES and isolated dextrocardia concurrence in the presented case resulted from different pathogenic mechanisms. Our findings suggest that ES might be caused by dysfunction in the acetylcholine receptor throughout fetal life, which may have affected muscle strength and movement. Other cardiac conditions include hypoplastic left-sided heart, Hypertrophic cardiomyopathy, patent ductus arteriosus, and heterotaxia.
Efficacy of combined naikan and morita therapies on psychological distress and posttraumatic growth in Chinese patients with advanced cancer
Authors: Han Xiang-Bei , Fang Yan-Qiu , Liu Shu-Xiang , Tan Yan , Hou Jun-Jie , Zhao Li-Jing , Li Feng
Published: August 2021

Background:

Advanced cancer (AC) patients experience serious physical and psychological problems with the disease progression. When approaching the end of life, these patients have to cope with not only the bodily illness, but also the spiritual crisis. Conventional psychological treatments reduce distress to a certain extent, but for patients with AC, especially when they face progressive illness and are approaching death, their psychological problems are complex, and no simple solutions are in sight. Therefore, we designed this study to evaluate the efficacy of the combined Naikan therapy (NT) and Morita therapy (MT) on psychological distress and posttraumatic growth in patients with AC.

Method:

One hundred thirty patients newly diagnosed with AC were allocated randomly into treatment (n = 65) and control (n = 65) groups. Patients in the treatment group received combined NT and MT for 7 consecutive weeks, while the control group received normal medical treatments without NT and MT. Patients were assessed before and after the therapies. The primary outcome measures include distress thermometer (DT) and posttraumatic growth, and the secondary outcome measure contains the list of distress problems.

Results:

At the post-treatment stage, the treatment group displayed a decreased score of psychological distress as compared to that in the control group, which accompanied by a higher post-traumatic growth total score and subscale scores in relationship to others, new possibilities, personal strength, spiritual changes, and appreciation of life. A significant decrease in fear, sleeping difficulty/insomnia, nervousness/anxiety, and loss of appetite was also observed in the treatment group.

Conclusion:

The results proved that the combined Naikan and Morita therapies decreased the psychological distress and improved the posttraumatic growth of the patients with AC.

Trial Registration:

ChiCTR1900026691.
Evaluation of different treatment modalities for fractured and non-fractured simple bone cyst
Authors: Deventer Niklas , Deventer Nils , Gosheger Georg , de Vaal Marieke , Budny Tymoteusz , Luebben Timo , Frommer Adrien , Vogt Bjoern
Published: August 2021

Simple bone cysts (SBCs) occur most frequently in the proximal aspect of the humerus and femur in growing age and are associated with intercurrent pathological fractures in up to 87%. Therapeutic management of SBCs remains controversial. The aim of this study was to examine the outcome of conservative and various surgical treatment modalities considering the specific anatomic location and integrity of the SBC.

In this retrospective study, we analyzed 68 cases of SBCs who underwent a conservative or surgical treatment between 2009 and 2020 with a mean follow-up of 30.1 months. The epidemiological characteristics, complications, clinical, and radiographic outcome after conservative or surgical treatment were assessed.

The study includes 50 male (73.5%) and 18 female (26.5%) patients with a mean age of 9.1 years. The most common locations were the proximal humerus (69.2%, n = 47) and femur (16.2%, n = 11). In 43 cases (63.2%; upper limb n = 40, lower limb n = 3) a pathological fracture occurred. Fifty patients (73.5%; upper limb n = 40, lower limb n = 10) underwent a conservative treatment. In 11 cases (16.2.1%; upper limb n = 4, lower limb n = 7) an intralesional curettage and defect reconstruction with bone substitute without stabilization were performed. Five patients (7.3%; upper limb n = 4, lower limb n = 1) received an osteosynthesis, in two cases (2.9%; upper limb 1; lower limb 1) combined with an intralesional curettage and defect reconstruction with bone substitute. All 32 pathological fractures treated conservatively (upper limb n = 31, lower limb n = 1) healed within 6 weeks; 17/43 patients (39.5%) suffered at least one second fracture. After intralesional curettage and defect reconstruction with bone substitute local recurrence was observed in 5/13 cases (38.5%). Spontaneous consolidation, at least partially, was observed in three cases (4.4%) following conservative treatment after fracture. No relevant secondary angular or torsional deformity was observed after treatment.

The majority of SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Load-dependent pain or the inability to mobilize timely after fracture can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution, especially after fracture, can be seen in rare cases.
Relationship between Helicobacter pylori infection and nonalcoholic fatty liver disease
Authors: Wei Lin , Ding Hui-Guo
Published: August 2021

Background:

The relationship between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. Although it has been studied in many observational studies, the results remain controversial. Therefore, we performed a meta-analysis to assess the association between H pylori infection and risk of NAFLD.

Methods:

We searched Pubmed, EMBASE, and Web of Science databases, from inception to September 10, 2020. Odds ratio (OR) and 95% confidence interval (CI) were pooled by random-effects model. The statistical heterogeneity among studies (I2-index), subgroup analyses, regression analyses, sensitivity analysis and the possibility of publication bias were assessed.

Results:

A total of seventeen studies involving 91,958 individuals were included in our meta-analysis. Meta-analysis of data from cross-sectional and case-control studies showed that H pylori infection was associated with increased risk of prevalent NAFLD (n = 15; involving 74,561 middle-aged individuals; OR1.38, 95% CI 1.23–1.55, I2 = 86.8%, P < .001). The results of meta-regression implicated that the study type and the case-control ratio impacted the total effect size. Funnel plot did not show significant publication bias. Meta-analysis of data from longitudinal studies showed that H pylori infection was also associated with increased NAFLD incidence (n = 2; involving 17397 individuals; OR 1.21, 95% CI 1.01–1.44, I2 = 6.5%, P = .301).

Conclusions:

The results indicated that a positive association between H pylori infection and the risk of NAFLD. Further studies are required to strengthen the association and clarify the mechanism.
Comparison of laparoscopic and open living donor hepatectomy
Authors: Gao Yuye , Wu Wu , Liu Chunyu , Liu Tao , Xiao Heng
Published: August 2021

Laparoscopic donor hepatectomy (LDH), accepted as a minimally invasive approach, has become increasingly popular for living donor liver transplant. However, the outcomes of LDH remain to be fully clarified when compared with open living donor hepatectomy. Thus, our meta-analysis was designed to assess the efficacy of laparoscopic in comparison with conventional open donor hepatectomy.

The PubMed, Cochrane, and Embase electronic databases were searched to identify the articles concerning the comparison of the efficacy of laparoscopic versus open surgery in treatment of living donor liver transplantation updated to March, 2020. The main search terms and medical Subject Heading terms were: “living donor,” “liver donor,” “minimally invasive,” “laparoscopic surgery,” and “open surgery.” After rigorous evaluation on quality, the data was extracted from eligible publications. The outcomes of interest included intraoperative and postoperative results.

The inclusion criteria were met by a total of 20 studies. In all, 2001 subjects involving 633 patients who received laparoscopic surgery and 1368 patients who received open surgery were included. According to the pooled result of surgery duration, the laparoscopic surgery was associated with shorter duration of hospital stay (MD = −1.07, 95% CI −1.85 to −0.29; P = .007), less blood loss (MD = −57.57, 95% CI −65.07 to −50.07; P < .00001), and less postoperative complications (OR = 0.61, 95% CI 0.44–0.85; P = .003). And the open donor hepatectomy achieved a trend of shorter operation time (MD = 30.31, 95% CI 13.93–46.69; P = .0003) than laparoscopic group. Similar results were found in terms of ALT (P = .52) as well as the AST (P = .47) peak level between the 2 groups.

LDH showed the better perioperative outcomes as compared with open donor hepatectomy. The findings revealed that LDH may be a feasible and safe procedure for the living donor liver transplantation.
Efficacy and safety of the recombinant human growth hormone in short children born small for gestational age
Authors: Kim Su Jin , Kim Min-Sun , Cho Sung Yoon , Suh Byung-Kyu , Ko Cheol Woo , Lee Kee-Hyoung , Yoo Han-Wook , Shin Choong Ho , Hwang Jin Soon , Kim Ho-Seong , Chung Woo Yeong , Kim Chan Jong , Han Heon-Seok , Jin Dong-Kyu
Published: August 2021

Objective:

Growth hormone (GH) treatment is known to be effective in increasing stature in children with a short stature born small for gestational age (SGA). This multicentre, randomized, open-label, comparative, phase III study aimed to evaluate the efficacy and safety of Growtropin-II (recombinant human GH) and to demonstrate that the growth-promoting effect of Growtropin-II is not inferior to that of Genotropin in children with SGA (NCT ID: NCT02770157).

Methods:

Seventy five children who met the inclusion criteria were randomized into 3 groups in a ratio of 2:2:1 (the study group [Growtropin-II, n = 30], control group [Genotropin, n = 30], and 26-week non-treatment group [n = 15]). The study and control groups received subcutaneous injections of Growtropin-II and Genotropin, respectively for 52 weeks, whereas the non-treatment group underwent a non-treatment observation period during weeks 0 to 26 and a dosing period during weeks 27 to 52 and additional dosing till week 78 only in re-consenting children.

Results:

No significant differences in demographic and baseline characteristics between the groups were observed. The mean ± standard deviation change difference in annualized height velocity (aHV) (study group - control group) was 0.65 ±2.12 cm/year (95% confidence interval [CI], −0.53 to 1.83), whereas the lower limit for the 2-sided 95% CI was −0.53 cm/year. Regarding safety, treatment-emergent adverse events (TEAEs) occurred in 53.33% children in the study group and 43.33% children in the control group; the difference in the incidence of TEAEs between the 2 treatment groups was not statistically significant (P 
= .4383). A total of 17 serious adverse events (SAEs) occurred in 13.33% children in the treatment groups, and no significant difference in incidence between groups (P 
= .7065) was seen. Two cases of adverse drug reaction (ADR) occurred in 2 children (3.33%): 1 ADR (injection site swelling or pain) occurred in 1 child (3.33%) each in the study and control groups.

Conclusions:

This study demonstrates that the change in aHV from the baseline till 52 weeks with Growtropin-II treatment is non-inferior to that with Genotropin treatment in children with short stature born SGA. Growtropin-II is well-tolerated, and its safety profile is comparable with that of Genotropin over a 1-year course of treatment.
The degree of agreement between score-based decision and clinician's discretion regarding the need for tracheotomy in oral cancer surgery
Authors: Abe Atsushi , Ito Yu , Hayashi Hiroki , Furuta Hiroshi , Ishihama Takanori , Adachi Moriyasu
Published: August 2021

In oral cancer surgery, the decision to perform a tracheotomy is often determined by the surgeon. In this study, we investigated the competency of clinical scoring systems in identifying patients who require tracheotomy and examined the degree of agreement between the surgeon's decision and the indications of various scoring systems. We identified 110 patients who were surgically treated for oral cancer. Of these, 67 patients (44 men and 23 women) who underwent resection and reconstruction were retrospectively analyzed. To derive the score, we evaluated the endpoint of the airway management score using clinical records and images. We divided the patients into two groups based on the Cameron and Gupta scores (tracheotomy and no-tracheotomy groups) and evaluated the degree of agreement with the surgeon's decision by calculating the κ coefficient. The κ coefficients of the Gupta and Cameron scores were 0.61 (95% confidence interval [CI]: 0.40–0.82) and 0.60 (95% CI: 0.38–0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Cameron and Gupta scores agreed fairly with the surgeon's decision. In this study, the Cameron and Gupta scores fairly agreed with the decision of experienced surgeons and were confirmed as acceptable guides for making clinical judgments.
The re-emergence from the COVID-19 epidemic of Beijing Xinfadi Market
Authors: Chen Haiqian , Shi Leiyu , Zhang Yuyao , Wang Xiaohan , Sun Gang
Published: August 2021

To provide references for global pandemic prevention and control, this study aimed to analyze the epidemiological characteristics and clinical manifestations of 103 new confirmed cases between June 12 and June 15, 2020, in Beijing. All confirmed cases in this study were tested with a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction and extracting data from the Beijing Municipal Health Commission (June 11 to July 6, 2020). We selected the 103 typical confirmed cases (excluding imported cases) between June 12 and June 15 for statistical analysis and explored differences among different clinical cases. A cluster of COVID-19 was reported in Beijing between June 12 and June 15, 2020, involving 103 confirmed cases. Patients aged 21 to 65 years old and the mean age was 42.38 ± 11.507, the male-to-female sex ratio was 1.40:1. All confirmed cases had a direct or indirect exposure history in the Beijing Xinfadi Market (BXM), and the clinical manifestations of 97% confirmed cases was diagnosed as mild or moderate. Different clinical classification in age (P = .041), exposure history (P = .025), fever (P = .020), and cough (P = .000) were the statistically significant difference, but there was no statistically significant difference in gender (P = .501), the type of diagnosis (P = .478), expectoration (P = .979), fatigue (P = .906), dizziness or headache (P = .848), muscle pain (P = .825), sore throat or throat discomfort (P = .852), chills (P = .933), diarrhea (P = .431) and runny nose or nasal congestion (P = .898). This study shows that Beijing's epidemic scope was mainly concentrated in the Xinfadi Market. The initial cases were epidemiologically related to the BXM, the clinical classification of most cases was mild and moderate, and the differences in age, exposure history, fever, and cough among different clinical cases were statistically significant.