bluuebunny/crossref_metadata_2025 huggingface dataset:
Vocal cord involvement and hoarseness in a patient with Behcets disease
Authors: Zhou Peng , Wu Qi , Li Jinnan
Published: May 2020

Rationale:

Behcets disease (BD) is a type of chronic systemic vasculitis that typically manifests as a mucocutaneous disease with orogenital ulcers, skin damage, and uveitis. The clinical diagnosis is often difficult because of the diversity of organs that may be involved and lack of specific pathological diagnosis.

Patient concerns:

A 26-year-old woman presented as a nearly 2-week history of hoarseness with throat pain.

Diagnoses:

In the present case, Fiber laryngoscopy showed multiple ulcers involving the epiglottic tubercle, bilateral false vocal cord, middle area of the left vocal cord, and full length of the right vocal cord. Multidisciplinary physicians combined the patients clinical manifestations and pathological findings to make the Behcets disease diagnosis.

Interventions:

As the diagnosis confirmed, immediately began appropriate medical therapy (prednisolone at 30 mg once per day and thalidomide at 50 mg once per night in a month).

Outcomes:

The ulcer on the right vocal cord disappeared but left a scar. Therefore, the patient experienced only partial recovery from the hoarseness.

Lessons:

Behcets disease can cause damage to multiple organs. Although the combination of vocal cord ulcers and hoarseness is rare in patients with BD and has not been previously reported to date, such patients should be treated with caution in clinical practice.
The process of obtaining informed consent to research in long term care facilities (LTCFs)
Authors: Tori Katerina , Kalligeros Markos , Shehadeh Fadi , Khader Rajamohammed , Nanda Aman , van Aalst Robertus , Chit Ayman , Mylonakis Eleftherios
Published: May 2020

We examined the process of obtaining informed consent (IC) for clinical research purposes in long-term care facilities (LTCFs) in Rhode Island (RI), USA. We assessed factors that were associated with resident ability to consent, such as Brief Interview for Mental Status scores. We used a self-administered questionnaire to further understand the effect of LTCF staff evaluation of ability to consent on residents’ autonomy and control over their medical decision making.

Observational clinical study

Long-term care setting.

LTCF personnel provided us with residents’ names, as well as their professional assessment of resident ability to consent. We used Brief Interview for Mental Status (BIMS) scores to assess the cognitive capacity of all residents to assess, and compare it to the assessment provided by LTCF personnel. A logistic regression analysis was performed to determine the relationship between LTCF assessment of resident ability to consent and BIMS score or confirmed diagnosis of dementia as seen from residents’ medical charts. A self-administered questionnaire was filled out by the personnel of 10 LTCFs across RI, USA.

LTCF personnel in 9 out of 10 recruited facilities reported that their assessment of resident ability to consent was based on subjective assessment of the resident as alert and oriented. There was a statistically significant relationship between the LTCF assessment of resident ability to consent and previously diagnosed dementia (OR: 0.211, 95% CI 0.107–0.415). Therefore, as BIMS scores increased, the likelihood that the resident would be deemed able to consent by LTCF personnel also increased. Furthermore, there was a statistically significant relationship between LTCF assessment of resident ability to consent and BIMS scores (OR: 1.430, 95% CI 1.274–1.605).

There is no standard on obtaining IC for research studies conducted in LTCFs. We recommend that standardizing the process of obtaining IC in LTCFs can enhance the ability to perform research with LTCF residents.
The methods of preoperative biliary drainage for resectable hilar cholangiocarcinoma patients
Authors: Chen Guo-Feng , Yu Wei-Di , Wang Ji-Ru , Qi Fu-Zhen , Qiu Yu-Dong
Published: May 2020

Objectives:

To compare the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients with resectable hilar cholangiocarcinoma (HCCA) and evaluate the effect of EBD and PTBD on tumor prognosis.

Materials and methods:

PubMed, EMBASE, and Cochrane Library databases were searched for articles about the comparison between PTBD and EBD. Data were analyzed by Revman 5.3.

Results:

PTBD showed a lower risk of drainage-related complications than EBD (OR, 2.73; 95%CI, 1.52–4.91; P < .05). PTBD was also associated with lower risk of pancreatitis (OR, 8.47; 95%CI, 2.28–31.45; P < .05). The differences in preoperative cholangitis, R0 resection, blood loss and recurrence showed no statistically significance between EBD and PTBD (all P > .05). Several literatures have reported the tumor implantation metastasis after PTBD. Since no well-designed prospective randomized controlled studies have explored in this depth, this article is unable to draw conclusions on this aspect.

Conclusion:

PTBD is a reasonable choice for PBD, and EBD should only be used as preoperative drainage for HCCA by more experienced physicians. There is a greater need to design prospective randomized controlled studies to obtain high-level evidence-based medicinal proof. It is worth noting that, whether EBD or PTBD, accurate selective biliary drainage should be the trend.
Acupuncture therapy for Alzheimer's disease
Authors: Wang Liaoyao , Xu Jia , Zhan Yijun , Pei Jian
Published: May 2020

Background:

Alzheimer's disease (AD) is the fifth-leading cause of death in people more than 65 years old. Acupuncture therapy has been traditionally used to treat various kinds of health problems including AD. This protocol aims to summarize the available evidence from current systematic reviews (SRs) for the efficacy of acupuncture therapy for AD.

Methods:

Seven databases will be searched: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP (CQVIP), and Chinese Biomedical Literature Database (CBM). SRs/meta-analyses (MAs) of acupuncture therapy for AD which were reported in Chinese or English will be included. Study selection, data extraction, and assessment of the study quality will be performed independently by 2 or more reviewers. And the methodological quality, report quality and evidence quality will be evaluated by Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool, Preferred Reporting Items for Systematic Reviews and Meta Analyses Statement (PRISMA) checklist and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, respectively.

Results:

The article in this overview will be submitted for publication in a peer-reviewed journal.

Conclusion:

We expect to compile evidence from multiple systematic reviews of acupuncture therapy in AD patients in an accessible and useful document.

Registration number: INPLASY202040035.
Lipoma in the pronator quadratus
Authors: Tian Heng , Qu Wen-rui , Pan Junbo , Zhu Zhe , Liu Jun , Li Rui
Published: May 2020

Rationale:

Lipomas are common benign tumors, constituting 16% of soft tissue mesenchymal tumors. They usually occur under the skin or in the large muscles of the thigh, shoulder, or upper arm. There are few reported cases of lipomas located in the forearm and hand muscles, accounting for less than 1% of all lipomas.

Patient concerns:

A 47-year old man presented with a history of swelling and accompanying pain in the left wrist for 2 years.

Diagnoses:

The patient was diagnosed with intramuscular lipoma in the pronator quadratus.

Interventions:

The mass was resected completely with wide-awake technique.

Outcomes:

The patient was followed up for 2 years with no recurrence. The symptoms of swelling and pain resolved within 3 weeks post-surgery, and there was no clear abnormality in wrist and finger movement and sensation. A satisfactory outcome was achieved.

Lessons:

Intramuscular lipoma in the pronator quadratus is a rare benign tumor which should be distinguished from malignant tumors. Especially for patients with carpal tunnel syndrome presenting with wrist swelling, ultrasound, computed tomography, or magnetic resonance imaging can be used to assess deep tissue masses.
Integrated miRNA-mRNA network revealing the key molecular characteristics of ossification of the posterior longitudinal ligament
Authors: Xu Guoyong , Liu Chong , Liang Tuo , Qin Zhaojie , Yu Chao Jie , Zhang Zide , Jiang Jie , Chen Jiarui , Zhan Xinli
Published: May 2020

Background:

Ossification of the posterior longitudinal ligament (OPLL) refers to an ectopic ossification disease originating from the posterior longitudinal ligament of the spine. Pressing on the spinal cord or nerve roots can cause limb sensory and motor disorders, significantly reducing the patient's quality of life. At present, the pathogenesis of OPLL is still unclear. The purpose of this study is to integrate microRNA (miRNA)-mRNA biological information data to further analyze the important molecules in the pathogenesis of OPLL, so as to provide targets for future OPLL molecular therapy.

Methods:

miRNA and mRNA expression profiles of GSE69787 were downloaded from Gene Expression Omnibus database and analyzed by edge R package. Funrich software was used to predict the target genes and transcription factors of de-miRNA. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis of differentially expressed genes (DEGs) were carried out based on CLUEGO plug-in in Cytoscape. Using data collected from a search tool for the retrieval of interacting genes online database, a protein-protein interaction (PPI) network was constructed using Cytoscape. The hub gene selection and module analysis of PPI network were carried out by cytoHubba and molecular complex detection, plug-ins of Cytoscape software respectively.

Results:

A total of 346 genes, including 247 up-regulated genes and 99 down-regulated genes were selected as DEGs. SP1 was identified as an upstream transcription factor of de-miRNAs. Notably, gene ontology enrichment analysis shows that up- and down-regulated DEGs are mainly involved in BP, such as skeletal structure morphogenesis, skeletal system development, and animal organ morphogenesis. Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that only WNT signaling pathway was associated with osteogenic differentiation. Lymphoid enhancer binding factor 1 and wingless-type MMTV integration site family member 2 Wingless-Type MMTV Integration site family member 2 were identified as hub genes, miR-520d-3p, miR-4782-3p, miR-6766-3p, and miR-199b-5p were identified as key miRNAs. In addition, 2 important network modules were obtained from PPI network.

Conclusions:

In this study, we established a potential miRNA-mRNA regulatory network associated with OPLL, revealing the key molecular mechanism of OPLL and providing targets for future treatment or prevent its occurrence.
Effect of acupuncture and auricular acupressure on smoking cessation
Authors: Dai Runjing , Zhang Jie , Zhang Hailiang , Zhao Na , Song Fujian , Fan Jingchun
Published: May 2020

Background:

Tobacco epidemic remains a major challenge to public health, with >7 million deaths attributable to tobacco smoking p.a. Quitting smoking is a proven way of reducing the harm of smoking. Nicotine replacement therapy (NRT), auricular acupressure and acupuncture are used for quit smoking, but it remains to be explored which is relatively more effective. Furthermore, a Bayesian network meta-analysis will be applied to determine the relative effects and/or safety of different smoking cessation treatments.

Methods/design:

A literature search for randomized controlled trials (RCTs) will be performed in five electronic databases from inception to December 2019, including PubMed, the Cochrane library, EMBASE, Web of Science, and Chinese Biomedical Database (SinoMed). Cochrane Collaboration quality assessment tool will be used for the risk of bias assessment. A Bayesian network meta-analysis will be performed using WinBUGS 1.4.3, and Stata 14 will be applied to draw the network diagram, while RevMan 5.3.5 will be used to produce funnel plot for assessing the risk of publication bias. Recommended rating, development and grade methodology will also be utilized to assess the quality of evidence.

Results:

We will evaluate the effect of different smoking cessation treatments (e.g., acupuncture, auricular acupressure, and NRT) by directly traditional meta-analysis and indirectly Bayesian network meta-analysis.

Conclusion:

Our study will provide smokers with the available evidence on the efficacy and safety of quitting regimens.
Intracoronary and peripheral blood levels of TNF-like Cytokine 1A (TL1A) in patients with acute coronary syndrome
Authors: Chen Xinjing , Guo Yansong , Lai Li , Zhang Shengli , Li Zhiliang
Published: May 2020

Background:

TNF-like cytokine 1A (TL1A) is a subgroup of the tumor necrosis factor superfamily that exerts pleiotropic effects on cell proliferation, inflammation, activation, and differentiation of immune cells. The purpose of the current study is to investigate the clinical significance of TL1A expression in coronary and peripheral blood of patients with acute coronary syndrome (ACS) to determine if TL1A levels can serve as an accurate prognostic indicator.

Methods:

A total of 141 patients undergoing coronary angiography were divided into 4 groups: Control (n = 35), Unstable Angina (UA) (n = 35), acute non-ST segment elevation myocardial infarction (NSTEMI) (n = 37), and acute ST segment elevation myocardial infarction (STEMI) (n = 34). The levels of TL1A, MPO, hs-CRP, and IL-10 were detected in coronary and peripheral blood using enzyme linked immunosorbent assay (ELISA), and the MACE incidence rates were compared during 26.3 months of follow-up.

Results:

TL1A levels were not significantly different between the UA group and control group. In the UA group, TL1A levels were not significantly different between coronary blood and peripheral blood. However, TL1A levels were higher in the STEMI and NSTEMI groups than in the control group (P < .05). Moreover, TL1A levels in the coronary blood of the STEMI and NSTEMI groups were higher than in the peripheral blood (P < .05). The expression of TL1A in the coronary blood was the highest in the STEMI group. In addition, TL1A level in the coronary blood was highly correlated with levels in the peripheral blood (correlation coefficient: 0.899, P < .001). The hs-CRP and MPO levels in the coronary and peripheral blood of all the UA, NSTEMI, and STEMI groups were higher than the control group. Plasma IL-10 levels in all the UA, NSTEMI and STEMI groups were lower than those in the control group. Plasma TL1A level was positively correlated with the cTnI level, degree of coronary thrombus burden, occurrence of slow coronary flow / no coronary reflow and MACE, but negatively correlated with the IL-10 level or non-correlated with the Syntax score.

Conclusion:

Plasma TL1A concentration levels can be used as a predictor of inflammatory response and prognosis in patients with ACS.

Trial Registration: ClinicalTrials.gov, number: NCT02430025; Unique Protocol ID: FJPH20150101; Brief Title: Fujian Province Cardiovascular Diseases Study (FJCVD)
Effects of gut microbiome and environment on the development of eczema in Chinese infants
Authors: Chan Carmen Wing Han , Leung Ting Fan , Choi Kai Chow , Tsui Stephen Kwok Wing , Chan Judy Yuet Wa
Published: May 2020

Background:

Eczema is a relapsing and persistent inflammatory skin disease affecting about one-fifth of children worldwide. As in other developed countries, the prevalence of this chronic disease in Hong Kong is approximately 30%. Moreover, the number of local cases reported has been on a rising trend since 1995. Eczema frequently starts in early infancy. A total of 45% of all cases begin within the first six months of life, 60% during the first year and 85% before the age of 5. The pathophysiology of eczema is multi-factorial and is a complex inter-relationship between skin barrier, genetic predisposition, immunologic development, microbiome, environment, nutrition, and pharmacological and psychological factors.

Objective:

To characterize the longitudinal changes of gut microbial profile in early childhood and to examine the association between gut microbiome diversity, environmental factors and the development of eczema in early childhood.

Method:

We will conduct a longitudinal cohort study that follows 1250 Hong Kong Chinese infants for 2 years and assess the gut microbiome and other potential environmental factors in the aetiology of eczema. Parents will be asked to provide demographic data, their infant birth data, allergy condition, diet, environmental conditions as well as the data on maternal stress. Stool specimen will be collected for gut microbiome diversity analysis. We will examine newborn infants at enrollment, at 4 months, 1 year and 2 years after birth.

Expected results:

This study will evaluate the association between gut microbiome, environmental factors and the development of eczema in Chinese infants. Findings from this study may be used to develop a predictive path model to guide effective health promotion, disease prevention and management.
Management of locally advanced synchronous colorectal and prostate cancers
Authors: Tey Yi Qing , Ravi Kavimalar , Chong Choon Seng , Chiong Edmund , Ho Jingshan , Tey Jeremy Chee Seong , Ho Francis
Published: May 2020

Introduction:

Synchronous colorectal and prostate malignancies are uncommon, with standard treatment guidelines not yet established. Chemoradiation therapy is involved in both colorectal and prostate cancers. However, differing dosage regimens and effects of irradiation field on anatomical planes for surgery makes management of the synchronous cancers challenging. We report the first case of synchronous prostate and rectal cancer being treated with a combination of treatment modalities with a unique addition of high dose rate prostate brachytherapy boost.

Patient concerns:

The patient, a 69-year-old Chinese gentleman, presented with per-rectal bleeding with alternating bowel habits and a hemoglobin drop. He also had a history of urinary urge incontinence.

Diagnosis:

Following diagnostic workup, he was diagnosed with synchronous rectal adenocarcinoma (T3N1M0) and prostate malignancy (T2bN0M0).

Interventions:

The management consisted of neoadjuvant androgen deprivation therapy (ADT) and pelvic chemoradiation, followed by high dose rate prostate brachytherapy boost and subsequently anterior resection.

Outcomes:

Following therapy, the patient has no evidence of local recurrence or distant metastasis.

Conclusion:

We suggest a new feasible treatment strategy for the management of synchronous colorectal and prostate cancers.
A bibliometric analysis and visualization of medical data mining research
Authors: Hu Yuanzhang , Yu Zeyun , Cheng Xiaoen , Luo Yue , Wen Chuanbiao
Published: May 2020

Background:

Data mining technology used in the field of medicine has been widely studied by scholars all over the world. But there is little research on medical data mining (MDM) from the perspectives of bibliometrics and visualization, and the research topics and development trends in this field are still unclear.

Methods:

This paper has applied bibliometric visualization software tools, VOSviewer 1.6.10 and CiteSpace V, to study the citation characteristics, international cooperation, author cooperation, and geographical distribution of the MDM.

Results:

A total of 1575 documents are obtained, and the most frequent document type is article (1376). SHAN NH is the most productive author, with the highest number of publications of 12, and the Gillies's article (750 times citation) is the most cited paper. The most productive country and institution in MDM is the USA (559) and US FDA (35), respectively. The Journal of Biomedical Informatics, Expert Systems with Applications and Journal of Medical Systems are the most productive journals, which reflected the nature of the research, and keywords “classification (790)” and “system (576)” have the strongest strength. The hot topics in MDM are drug discovery, medical imaging, vaccine safety, and so on. The 3 frontier topics are reporting system, precision medicine, and inflammation, and would be the foci of future research.

Conclusion:

The present study provides a panoramic view of data mining methods applied in medicine by visualization and bibliometrics. Analysis of authors, journals, institutions, and countries could provide reference for researchers who are fresh to the field in different ways. Researchers may also consider the emerging trends when deciding the direction of their study.
The success of opening concurrent chronic total occlusion lesion to improve cardiac function trial in patients with multi-vessel disease (SOS-moral)
Authors: Tian Jinfan , Zuo Huijuan , Zhang Lijun , Zhang Mingduo , Zhang Dongfeng , Zhang Min , Zhou Yuan , He Yi , Mi Hongzhi , Yang Xueyao , Huang Rongchong , Song Xiantao
Published: May 2020

Aims:

The purpose of the present trial is to determine whether opening co-existing chronic total occlusions (CTOs) using percutaneous coronary interventions (PCIs) improves cardiac function in patients with multi-vessel disease (MVD). Patients with MVD are defined as having at least one additional major vessel exhibiting no less than 75% stenosis combined with the presence of a CTO artery.

Methods and results:

Patients will be prospectively recruited who meet the following criteria:

Patients presenting with no necrosis of myocardial tissue in the territory of the CTO will be excluded. Recruited patients will be randomized into 2 groups: those undergoing PCI of only the non-CTO artery (non-CTO PCI group), and those undergoing PCI of the non-CTO artery concurrently with the CTO artery (CTO-PCI group). The primary outcome will be the change in cardiac function evaluated via CMR at a 12-month of follow-up appointment, which will be compared to a baseline measurement. Secondary outcomes include occurrence of major cardiac events, CMR-assessed myocardial viability in the CTO-supplied territory, and quality of life assessed by Seattle angina questionnaire, Patient Health Questionnaire 9 and Generalized Anxiety Disorder Scale-7 after 12-month follow-up.

Conclusion:

The SOS-moral trial will provide data necessary to determine whether to open concurrent CTOs among MVD patients with CMR-detected necrotic myocardial tissue.
Transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis
Authors: Zhao Chen , Luo Lei , Pu Xiaobing , Liu Liehua , Li Pei , Liang Lichuan , Luo Fei , Hou Tianyong , Dai Fei , Xu Jianzhong , Zhou Qiang
Published: May 2020

The aim of this study was to evaluate the clinical and imaging results of transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis (TB) with a minimum 5-year follow-up.

Sixty-five patients who presented with active thoracic and lumbar TB between October 2006 and August 2013 were retrospectively analyzed: 20 were thoracic TB (group A), 17 were thoracolumbar TB (group B), and 28 were lumbar TB (group C). The patient data, operating time, blood loss, Visual Analog Scale score, Oswestry Disability Index score, correction of kyphosis, recovery of neurological function, and complications were recorded and analyzed.

The patients were followed for 68.7 ± 17.8 months. The preoperative average Cobb angles of kyphosis in patients in groups A, B, and C significantly decreased from 28.2 ± 11.9°, 30.5 ± 16.9°, and 10.9 ± 8.8° before surgery to 8.0 ± 5.4°, 5.0 ± 4.1°, and –4.4 ± 1.6° (– indicates lordosis) after surgery, respectively. At the final follow-up time, the Cobb angles were 9.2 ± 6.1°, 6.8 ± 10.0°, and -3.7 ± 2.0°, respectively. The postoperative Cobb angles of kyphosis were significantly improved in all groups (P < .05). The correction loss angles were larger in groups A and B than in group C (P > .05). The operating time, blood loss, and complications were not significantly different between the groups (P > .05). Three (4.6%) patients developed unhealed TB during postoperative anti-TB treatment, and 6 patients (9.2%) with TB relapsed after healing from surgery.

The posterior-only approach for the surgical treatment of thoracic and lumbar TB achieved satisfactory outcomes over long-term follow-up. The implantation of pedicle screws in diseased vertebrae reduced the range of fixation, but patients with thoracic and thoracolumbar TB should undergo fixation to at least 1 adjacent normal segment. There were some cases of recurrence after TB healed, and long-term follow-up is therefore necessary.
Fatal fulminant community-acquired pneumonia caused by hypervirulent Klebsiella pneumoniae K2-ST86
Authors: Yamamoto Hiroyuki , Iijima Anna , Kawamura Kumiko , Matsuzawa Yasuo , Suzuki Masahiro , Arakawa Yoshichika
Published: May 2020

Rationale:

Invasive community-acquired infections, including pyogenic liver abscesses, caused by hypervirulent Klebsiella pneumoniae (hvKp) strains have been well recognized worldwide. Among these, sporadic hvKp-related community-acquired pneumonia (CAP) is an acute-onset, rapidly progressing disease that can likely turn fatal, if left untreated. However, the clinical diagnosis of hvKp infection remains challenging due to its non-specific symptoms, lack of awareness regarding this disease, and no consensus definition of hvKp.

Patient concerns:

A 39-year-old man presented with high-grade fever and sudden-onset chest pain. Laboratory testing revealed an elevated white blood cell count of 11,600 cells/μl and C-reactive protein level (>32 mg/dl). A chest X-ray and computed tomography revealed a focal consolidation in the left lower lung field.

Diagnosis:

Diagnosis of fulminant CAP caused by a hvKp K2-ST86 strain was made based upon multilocus sequencing typing (MLST).

Interventions:

The patient was treated with ampicillin/sulbactam.

Outcomes:

The pneumonia became fulminant. Despite intensive care and treatment, he eventually died 15.5 hours after admission.

Lessons:

This is the first case of fatal fulminant CAP caused by a hvKp K2-ST86 strain reported in Japan. MLST was extremely useful for providing a definitive diagnosis for this infection. Thus, we propose that a biomarker-based approach should be considered even for an exploratory diagnosis of CAP related to hvKp infection.
Gastric adenocarcinoma of the fundic gland type
Authors: Fan Xue , Yang Xue-Song , Bai Peng , Ren Yu-Bo , Zhang Lei , Li Xin , Wang Li , Wang Yan , Ding Yi-Ming , Zeng Ran-Ran , Lin Xiang-Chun
Published: May 2020

Introduction:

Gastric adenocarcinoma of the fundic gland type (GA-FG) is a newly described entity that is characterized by well-differentiated neoplasm with unclear etiopathogenesis.

Patient concerns:

A 60-year-old Chinese man was referred to our hospital for abdominal distension.

Diagnosis:

Esophagogastroduodenoscopy (EGD) showed a depressed lesion found using in the greater curvature of the stomach. The pathological diagnosis of the biopsy specimens indicated that the tumor was GA-FG (chief cell predominant type, GA-FG-CCP).

Interventions:

Endoscopic submucosal dissection (ESD) was performed. The histopathological examination of the ESD specimen revealed gastric hyperplasia of the fundic gland type around the adenocarcinoma cells.

Outcomes:

The surgical outcomes were good. The EGD showed a scar with no recurrence, and no symptoms were observed 1 year postoperatively during the follow-up.

Conclusion:

We present a rare case of a depressed lesion with a pathogenic expression suggesting gastric hyperplasia of the fundic gland type around the adenocarcinoma cells. Considering the origin of oxyntic mucosa, we consider that it may develop into GA-FG. To understand this issue better, similar cases should be monitored in the future.
The effect of Qigong Wuqinxi for osteopenia and primary osteoporosis
Authors: Liu Min , Liu Dongying , Hong Peipei , Qiu Xianliang , Chen Qiu
Published: May 2020

Introduction:

Osteoporosis (OP) and related fragility fractures are a significant public health problem which leads to pain, disability, loss function of independence, considerable complications and increased mortality. Exercise training is the only alternative strategy to improve multiple skeletal and fall risk factors simultaneously. Wuqinxi is 1 of the Chinese mind-body exercises using to improve physical and mental health and fight against diseases for thousands of years. Our study aims to systematically review the existing literature to further explore the efficacy and safety of Wuqinxi in the prevention and treatment of osteopenia and OP.

Methods and analysis:

The following electronic databases (PubMed, Science Citation Index, Embase (Ovid) database, the Cochrane Library, the China National Knowledge Infrastructure, the China Biology Medicine disc, the China Science and Technology Journal Database, the Wan fang Database, ClinicalTrials.gov and the Chinese Clinical Trial Registry Platform) will be searched from the beginning to 1 June 2020. Only randomized controlled trials will be enrolled, in which the intervention group must include a form of Wuqinxi, while the control group can involve other conventional treatment or no intervention. The potential outcome measures will include bone mineral density values, bone turnover markers, fragility fractures, quality of life, pain scores, and adverse events. The Cochrane risk of bias assessment tool will be used to assess the risk of bias in each study.

Results:

The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the third quarter of 2021.

Conclusion:

This review aims to evaluate up-to-date evidence of Wuqinxi for bone health in English or Chinese language studies, and explore whether Wuqinxi can be used as an adjuvant treatment for osteoporosis and osteopenia.

Ethics and dissemination:

Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print.

Protocol registration number:

INPLASY202040135.
Risk factors for obstructive complications after endoscopic correction of vesico-ureteral reflux using polyacrylate polyalcohol copolymer
Authors: Sizonov Vladimir V. , Kagantsov Ilya M. , Mayr Johannes M. , Akramov Nail R. , Pirogov Aleksandr V. , Gasanov Zhalil A.
Published: May 2020

Use of polyacrylate-polyalcohol copolymer (PPC) after endoscopic correction (EC) of vesico-ureteral reflux (VUR) is highly effective but is associated with a higher risk of obstructive complications (OC) compared with other implants. We undertook a STROBE compliant retrospective investigation and studied the OC risk factors to increase the practical safety of PPC.

Overall, 798 patients (464 [58.1%] girls and 334 [41.9%]) boys) from 5 hospitals in whom PPC was routinely used were evaluated retrospectively. The patients were subdivided into 2 groups. Group I consisted of 754 (94.5%) children (449 [59.5%] girls and 305 [40.5%] boys) without OC. Median age was 41 months [Q1: 18.0; Q3: 81.0]. Group II comprised 44 (5.5%) patients (29 [65.9%] boys and 15 [34.1%] girls) experiencing OC, and their median age was 21.5 months [Q1: 12.0; Q3: 43.0]. Clinical and renal ultrasound examinations were carried out 1 day and 1 month after EC, and then every 6 months after EC. At the follow-up examination approximately 6 months after EC, voiding cysto-urethrography (VCUG) was performed. All patients with OC underwent diuretic renography.

OC occurred in 44 (5.5%) of 798 children, in some cases as late as 60 months after endoscopic injection of the bulking agent PPC for correction of VUR. Univariate analysis revealed that younger age (P < .001), higher grade of VUR (P < .001), male gender (P < .001), second injection (P = .003), and EC injection using hydrodistension implantation technique (HIT; P < .001) represented significant risk factors. At multivariate analysis, only male gender (P = .0078), younger age (P = .0044), HIT technique (P < .0001), and second injection (P = .04) represented significant risk factors for the occurrence of OC.

We identified young age, male gender, high reflux grade, HIT technique, and second endoscopic injections as factors associated with the risk of OC after EC of VUR using PPC as a bulking agent. Thus, patients who have undergone EC with PPC must be monitored sonographically for occurrence of OC for at least 60 months after the intervention.
Surgical stabilization of spinal metastasis in diffuse idiopathic skeletal hyperostosis (“Mets-on-DISH”)
Authors: Kawabata Atsuyuki , Hirai Takashi , Tohara Ryo , Yuasa Masato , Inose Hiroyuki , Koyanagi Hirotaka , Sato Shingo , Utagawa Kurando , Hashimoto Jun , Okawa Atsushi , Yoshii Toshitaka
Published: May 2020

Rationale:

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH.

Patient concerns:

A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2).

Diagnosis:

Two patients were diagnosed with spinal Mets and DISH.

Interventions:

Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms.

Outcomes:

A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2.

Lessons:

Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.
A single-center clinical study of hepatic artery variations in laparoscopic pancreaticoduodenectomy
Authors: Zhang Wei , Wang Kun , Liu Songyang , Wang Yingchao , Liu Kai , Meng Lingyu , Chen Qingmin , Jia Baoxing , Liu Yahui
Published: May 2020

Hepatic artery variations increase the difficulty of laparoscopic pancreaticoduodenectomy (LPD). The safety and efficacy of LPD in the presence of aberrant hepatic arteries (AHA) must be further verified.

Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. Variation type, intraoperative management, and clinical treatment outcomes were compared.

There were 54 cases (24.8%) of AHA. The most common hepatic artery variation was accessory right hepatic artery (RHA) from the superior mesenteric artery (SMA, n = 12, 5.5%), followed by replaced RHA from the SMA (n = 10, 4.6%), accessory left hepatic artery from the SMA (n = 10, 4.6%), and replaced common hepatic artery from the SMA (n = 6, 2.8%). Each type of arterial variation was successfully preserved in all cases, and there were no significant effects on the evaluated surgical indices, conversion rate, incidence of postoperative complications, or follow-up results.

Our findings indicated that preservation of AHAs during total LPD is feasible. There were no significant effects on surgical indices, incidence of postoperative complications, or follow-up outcomes.

The influence of AHA on the safety and efficacy of LPD must be further verified. Patients with normal and variant hepatic arteries who underwent LPD and preoperative arterial angiography were retrospectively analyzed. There were 54 cases (24.8%) of AHA. There were no significant effects of AHAs on surgical indices, incidence of postoperative complications, or follow-up outcomes.
A Chinese family of autosomal recessive polycystic kidney disease identified by whole exome sequencing
Authors: Zhang Jun , Dai Li-meng , Li Fu-rong , Zhang Bo , Zhao Jing-hong , Cheng Jin-bo
Published: May 2020

Background:

Autosomal recessive polycystic kidney disease (ARPKD) is an autosomal recessive hepatorenal fibrocystic syndrome. The majority of ARPKD patients progress to end-stage renal disease. Precise molecular diagnosis of ARPKD has proven valuable for understanding its mechanism and selecting optimal therapy.

Methods:

A Chinese family with ARPKD was recruited in current study. The clinical characteristics of ARPKD patient were collected from medical records and the potential responsible genes were studied by the whole exome sequencing (WES). Candidate pathogenic variants were validated by Sanger sequencing.

Results:

Both renal manifestation and hepatobiliary phenotype were observed. WES revealed compound heterozygous mutations of polycystic kidney and hepatic disease 1 genes, NM_138694: c.751G>T, (p.Asp251Tyr) and c.3998_4004delACCTGAA (p.Asn1333Thr fs × 13), which were confirmed by Sanger sequencing. Moreover, the mutations in the proband and its affected sib were co-segregated with the phenotype.

Conclusions:

The novel mutation in polycystic kidney and hepatic disease 1 gene identified by WES might be molecular pathogenic basis of this disorder.
The 95% effective dose of nalbuphine in patient-controlled intravenous analgesia for patients undergoing laparoscopic total hysterectomy compared to equivalent sufentanil: Retraction
Authors: Sun Zhentao , Zhu Zefei , Yang Guanyu , Zheng Hongyu
Published: May 2020

Purpose:

To evaluate the 95% effective dose of nalbuphine in patient-controlled intravenous analgesia (PCIA) by the sequential method and compare the analgesia efficacy with the equivalent dose of sufentanil on patients undergoing laparoscopic total hysterectomy.

Methods:

In the first part, we defined a successful analgesia as the highest VAS ≤3 in 24 hours postoperatively. On the contrary, a failed analgesia was the highest VAS>3. According to the last patient's outcome, the next patients would be given an increase or decreased dose grade. This process ended up with 9 cross-over points. In the second part, 60 patients undergoing laparoscopic total hysterectomy were selected. They were randomly divided into 2 groups (n = 30 each group): receiving sufentanil 1.78 μg/kg (group S) and nalbuphine 1.78 mg/kg (group N). PCIA pump was given at the end of the operation with 5 mL bonus loading. The total amount of PCIA was 100 mL and programmed to deliver 0.5 mL each time with a lockout interval of 15 minutes and the background infusion amount of 2 mL/h. The VAS score and Ramsay score of were collected after the operation, the number of effective pressing times of PCIA were also recorded. Adverse reactions were documented in detail.

Results:

The 95% effective dose of nalbuphine in PCIA on patients undergoing laparoscopic total hysterectomy was 1.78 mg/kg. There was no significant difference in VAS between the sufentanil group and the nalbuphine groups (P > .05), but the number of the use of PCIA in the group S was more than that in the group N obviously (P <.05). The group S has a lower ramsay sedation score than group N at every time point. (P <.05). The incidence of nausea and vomiting was not statistically significant differences between two groups in the first 24 hours after colonoscopy (P >  q .05).

Conclusion:

Nalbuphine 1.78 mg/kg in PCIA is recommended for the patients undergoing laparoscopic total hysterectomy. And nalbuphine is a reasonable alternative to sufentanil when used in PCIA.
Dialysate glucose response phenotypes during peritoneal equilibration test and their association with cardiovascular death
Authors: Wang Zheng , Yu Dahai , Cai Yamei , Ma Shuang , Zhao Bin , Zhao Zhanzheng , Simmons David
Published: May 2020

Different measures of rates of transfer of glucose during the peritoneal equilibrium test (PET), undertaken during peritoneal dialysis (PD) might provide additional information regarding a patient's risk of future cardiovascular mortality. This study aimed to characterize the heterogeneity of dialysate glucose (DG) response phenotypes during the PET and compare the cardiovascular mortality rates associated with the different phenotypes. Our cohort was derived from Henan peritoneal dialysis registry. A total of 3477 patients initiating PD in 2007 to 2014 had the DG measured at 0, 2-hour and 4-hour (D0, D2, and D4 respectively) during the PET for estimation of D2/D0 and D4/D0. Deaths mainly due to CVD within 2 years since the initiation of PD were defined as the outcome. Latent class mixed-effect models were fitted to identify distinct phenotypes of the DG response during the PET. Multivariable unconditional Logistic regression models with adjustment for cardiometabolic risk factors were used to compare the 2-year risk of cardiovascular mortality among patients in the different latent classes. Three distinct DG response phenotypes during the PET were identified. Those with consistently high D2/D0 and D4/D0 ratios had a 1.22 [95% confidence interval: 1.02, 1.35] excess risk of a cardiovascular death within 2 years of commencing PD compared with patients with the lowest D2/D0 ratio and decreased D4/D0 ratio after adjustment for cardiometabolic risk factors. Consistently elevated D2/D0 and D4/D0 ratios during the PET are associated with an increased risk of 2-year cardiovascular mortality independent of other cardiometabolic risk factors. In view of the potential bias due to unmeasured confounders (eg, Family history of cardiovascular diseases, and dietary patterns), this association should be further validated in other external cohorts.
Therapies for diabetic gastroparesis
Authors: Wang Shengju , Wang Ruili , Zhang Yanli , Zhang Xu , Cai Baochao , Lu Yan , Xia Yuguo , Chen Qiu
Published: May 2020

Background:

Diabetic gastroparesis (DG) is a common autonomic neuropathy which impacts on nutritional state and quality of life in diabetic patients, and it also adversely affects glycemic control in diabetes. The prevalence of DG is growing with the number of patients with diabetes continues to increase. However, there is no definitive answer as to which of the current therapies is the best for the clinical treatment of the different manifestations of DG. The subject of this study is to answer the following question: what is the best intervention for diabetic patients with gastroparesis?

Methods:

Comprehensive searches of the Cochrane Library, PubMed, Embase, Medline, Central and Web of Science, and 4 Chinese databases, including China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database, and WanFang will be completed using the following keywords DG and therapies and related entry terms. Studies will be included, according to the eligibility criteria (randomized controlled trials and controlled clinical trials, considering specific outcome measures for DG). The reference lists of included studies will be manual searched. Relevant data will be extracted from included studies using a specially designed data extraction sheet. Risk of bias of the included studies will be assessed, and the overall strength of the evidence will be summarized through GRADE. A random effects model will be used for all pairwise meta-analyses (with a 95% confidence interval). A Bayesian network meta-analysis will explore the relative benefits between the various therapies. The review will be reported using the Preferred Reporting Items for Systematic Reviews incorporating Network Meta-Analyses statement. Network meta-analysis will be performed using a Bayesian framework through the Winbugs software.

Results:

This network meta-analysis will identify the best effective therapy for DG.

Conclusion:

This study will compare and evaluate current therapies for DG, and find the best treatment of DG.
A rare case of inflammation after total hip arthroplasty due to a malpositioned prosthesis
Authors: Wang Jun , Zhang Miao , Xu Yun , Li XiaoJing , Wang CongCong , Gao XiaoPeng , Xu Meng , Li XiaoPeng , Li Wei , Wang Jun , Zhang YiMin , Wang GuoWei , Cao XueJun
Published: May 2020

Rationale:

Although prosthetic loosening caused by poor prosthesis positioning is common after total hip arthroplasty (THA), an inflammation caused by poor prosthesis positioning is rare. We report a case in which a THA-related inflammation was indeed caused by poor prosthesis positioning.

Patient concerns:

A 64-year-old woman was admitted to our hospital with a history of persistent hip pain that had started after she had undergone THA 4 years previously. In addition, she complained of swelling of the hip that had begun 2 months ago.

Diagnosis:

Her pain and swelling was initially thought to be caused by an infection, but was eventually diagnosed as inflammation caused by prosthesis loosening, that was in line with finding that her preoperative and intraoperative cultures showed no bacterial or fungal growth. This case posed many questions and difficulties during the diagnostic and treatment stages.

Interventions:

Routine diagnosis of periprosthetic suspected infection includes blood test, erythrocyte sedimentation rate, C-reactive protein level, bacterial and fungal cultures, and pathology examinations, which were performed. Finally, this case was eventually diagnosed as inflammation, the prosthesis was removed and antibiotics administered. It was replaced 6 months later.

Outcomes:

Except for the erythrocyte sedimentation rate and C-reactive protein levels, X rays, routine blood tests, bacterial and fungal cultures (3 times), and other tests were within the normal range. Positive pathological examinations of synovium during and after the operation indicated chronic inflammation and eliminated inflammation in other areas. Postoperative effect of the second-stage THA was good, with the patient highly satisfied after 6 months.

Lessons:

The operative method and position of a joint prosthesis are extremely important. A poorly positioned prosthesis worsens with wear. Wear particles then lead to long-term localized aseptic inflammation with swelling and fever and eventually to low-virulence infection. Prosthetic loosening may be found even at long-term follow-up evaluations after THA in patients with a poorly positioned prosthesis, eventually leading to the need for revision. We had 2 questions: should early revision be considered when a prosthesis had not been properly positioned? In the absence of any confirmation of infection, should a patient suspected of having a periprosthetic infection be treated as early as possible?