bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-expandable metal stent of esophagogastric junction versus pyloric area obstruction in advanced gastric cancer patients
Authors: Kim Deok Yeong , Moon Hee Seok , Kwon In Sun , Park Jae Ho , Kim Ju Seok , Kang Sun Hyung , Lee Eaum Seok , Kim Seok Hyun , Lee Byung Seok , Sung Jae Kyu , Jeong Hyun Yong
Published: August 2020

Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions.

To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer.

Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement.

The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement (P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] (P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement.

The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.
Anabolic steroids-induced delirium
Authors: Khoodoruth Mohamed Adil Shah , Khan Adeel Ahmad
Published: August 2020

Introduction:

Anabolic steroids are commonly used by athletes, body builders, and young adults to improve muscle strength. Deleterious effects of anabolic steroids on physical health are well-established. Psychiatric aspects are of particular importance and include psychosis, delirium, mania, depression, and aggression. We describe the case of a young gentleman who was managed as a case of androgenic steroid induced delirium.

Patient concern:

A 33-year-old gentleman presented with increased aggression, hostility, and destructive impulses. He was a regular user of testosterone propionate, testosterone cyprionate and trenbolone acetate up to 200 mg daily in injectable form. His mental status examination showed labile effect, flight of ideas and persecutory delusions. Physical examination was positive for atrophic testes. Laboratory results showed a decreased plasma testosterone level of 9.59 nmol/l (10.4–37.4 nmol/l). Sex Hormone Binding Globulin was 23.8 nmol/l (18.3–54.1 nmol/l) and bioavailable testosterone was 5.110 nmol/l (4.36–14.30 nmol/l).

Diagnosis:

He was diagnosed as a case of anabolic steroids induced delirium.

Interventions and outcome:

Patient was treated with regular haloperidol and quetiapine after which his sensorium, speech and behavior improved. He was discharged on haloperidol 7.5 mg and quetiapine 700 mg daily.

Conclusion:

The purpose of this case report is to emphasize on the neuropsychiatric effects and management of anabolic steroids manifested by delirium, increased aggression, hostility, and destructive impulses.
Pediatric tuina for the treatment of fever in children
Authors: Chen Long-Fang , Yin Ming , Dong Xing , Zou Jia-Xi , Wang Bai-Xue , Chen Ji
Published: August 2020

Background:

Infantile fever is a common symptom of the pediatric diseases, which is often caused by cold, food accumulation, or other pathogenic factors. Pediatric tuina is regarded as an acceptable non-pharmaceutical therapy for children with optimal effects, which has been widely used for infantile fever around China. But there is still a lack of systematic evaluation and research on its safety and effectiveness during the treatment of infantile fever. Thus the protocol is to collect clinical evidence and demonstrate the efficacy and safety of antipyretic manipulation by pediatric tuina.

Methods:

The systematic electronic search will be executed in Cochrane Library (1991–2020.6), EMBASE (1980–2020.6), PubMed (1996–2020.6), WHOICTRP (2004–2020.6), Web of Science (1900–2020.6), CNKI (1994–2020.6), CBM (1994–2020.6), WANFANG (1980–2020.6), and VIP (2000–2020.6) Database. The Review Manager (V.5.3) will be use to assess the risk of bias and data analyses. The methodological quality will be assessed by using the online GRADEpro tool. If the quality of numeric data is favorable, a meta-analysis will be carried out.

Results:

A high-quality evidence of pediatric tuina for the treatment of infantile fever.

Conclusion:

The systematic review will provide a reliable basis for judging whether pediatric tuina is safe and effective in the treatment of pediatric fever.

INPLASY Registration number:

INPLASY202060032
Association between tumor necrosis factor α and uterine fibroids
Authors: Gao Li-nan , Ge Lian-gang , Zhu Ming-zhe , Yao Xin-xin
Published: August 2020

Background:

This study will explore the association between tumor necrosis factor α (TNF-α) and uterine fibroids (UFs).

Methods:

We will retrieve electronic databases in Cochrane Library, PUBMED, EMBASE, Web of Science, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present. All potential case-controlled studies investigating the association between TNF-α and UFs will be included in this study. Two researchers will independently select literature, appraise study quality, and extract outcome data. We will utilize a fixed-effects model or a random-effects model to synthesize outcome data. All data analysis will be performed by RevMan 5.3 software.

Results:

The present study will supply high-quality synthesis and/or descriptive analysis of the recent evidence to explore the association between TNF-α and UFs.

Conclusion:

This study will exert evidence to determine whether or not TNF-α is associated with UFs.

Study registration number:

INPLASY202070010.
Long-term neurodevelopment outcomes of regional vs general anesthesia for infants undergoing inguinal herniorrhaphy
Authors: Yuan Tao , Yang Wenming , Yang Lei , Liu Xueting , Yang Lie , Li Yu
Published: August 2020

Background:

Whether regional anesthesia (RA) offers better long-term neurodevelopment outcomes compared to general anesthesia (GA) to infants undergoing inguinal herniorrhaphy is still under heated debate. The aim of this meta-analysis is to compare the long-term neurodevelopment impact of RA with GA on infants undergoing inguinal herniorrhaphy.

Methods:

A systematic search of MEDLINE, EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and controlledtrials.com will be performed. Published eligible randomized controlled trials (RCTs) or quasi-RCTs (including abstracts) through May 20, 2020 with language limit of English will be enrolled in the meta-analysis. Two reviewers will independently conduct the procedures of study selection, data extraction, methodological quality assessment, and risk of bias assessment. The primary outcome is long-term neurodevelopmental state (at 2- and 5-year follow-up) as reflected in the Bayley and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scales of infants development following surgeries. The secondary outcomes consist of satisfactory intraoperative infants immobility, duration of surgery, any anesthetic failure, the supplement of postoperative analgesia, postoperative apnea, and postoperative bradycardia. The pooled weighted mean differences (WMDs) or odds ratios (ORs) of each outcome measurement and relative 95% confident intervals (CIs) will be calculated. EndNote X8 (Clarivate Analytics) software will be applied to manage all citations. The Cochrane Review Manager version 5.3 software (RevMan 5.3) will be employed for statistical analysis.

Discussion:

This study will summarize scientific and practical evidence and provide evidence-based individualized decision-making guidance on anesthesia regimen for inguinal herniorrhaphy in infants.

Registration:

This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 17 June 2020 (registration number INPLASY202060064).
Retinal nerve fiber layer changes in migraine
Authors: Lin XiaoGuang , Yi ZhongQuan , Zhang XueLing , Liu QinQin , Cai RuYuan , Chen ChaoChun , Zhang HongJie , Zhao PanWen , Pan PingLei
Published: August 2020

Background:

Migraine is a common neurological disease, which seriously affects the quality of life and daily activities of patients. Although migraine is a transient phenomenon of cerebral vasoconstriction, it is well documented that recurrent attacks of migraine may lead to abnormalities in retinal structure. Optical coherence tomography (OCT) is a sensitive method to detect subtle damage in retinal nerve fiber layer (RNFL). There have been many studies investigating the difference in RNFL thickness with optical coherence tomography (OCT) between migraine patients and healthy controls. However, the results were not consistent. Our purpose is to perform a meta-analysis to investigate RNFL alterations in migraine.

Methods:

We will search PubMed, Embase, Web of science for studies assessing the differences in RNFL measured by OCT between patients with migraine and healthy controls. Case-control studies published in English will be included. Two reviewers will independently screen eligible articles, extract data, and assess quality. This meta-analysis will synthesize selected research data and compare the difference in RNFL thickness between patients with migraine and healthy controls. We will use Stata 15 in this meta-analysis. I2 statistics will be used to assess heterogeneity. If I2 ≤ 50%, the data are synthesized will use a fixed effect model. Otherwise, a random effect model will be performed. Publication bias will be determined by the Egger test. The methodological quality of all included studies will be evaluated by the Newcastle-Ottawa Scale (NOS). We will perform subgroup analysis, sensitivity analysis, and meta-regression analysis to test the robustness of the results.

Results:

We will obtain quantitative results regarding the difference in RNFL thickness between migraine patients and healthy controls. The results will be published in a peer-reviewed journal.

Conclusions:

The results of this study provide a high-quality synthesis of existing evidence and provide a basis for assessing the effect of migraine on the thickness of RNFL.

Registration number:

INPLASY 202060033
An 11-year retrospective study: clinicopathological and survival analysis of gastro-entero-pancreatic neuroendocrine neoplasm
Authors: Liu Hua , Xie Rongli , Zhao Zhifeng , Xu Dan , Yang Kaige , Ding Min , Tan Dan , Liao Wenqiang , Han Xujie , Zhang Jun , Shen Dongjie , Yuan Jianmin , Xu Zhiwei , Fei Jian
Published: August 2020

To investigate the clinicopathological characteristics and relevant prognostic factors of gastro-entero-pancreatic neuroendocrine neoplasm (GEP-NEN), to improve our understanding of GEP-NEN.

This was a retrospective analysis of 155 patients (average age 53.7 ± 13.6 years) pathologically diagnosed with GEP-NEN. We analyzed the clinicopathological characteristics, treatment, and prognostic factors of GEP-NEN.

The most common primary site was the pancreas (41.9%), followed by the rectum, stomach and duodenum. Most cases were nonfunctional GEP-NENs (149/155) with nonspecific symptoms. TNM stage and histological grade were determined by the latest criteria. Surgical resection was the mainstay of treatment in 150 patients, and 22 patients received chemotherapy under different circumstances. A total of 130 patients were followed up for a median of 44 months, and 1-year and 3-year survival rates were 82.3% and 72.3%, respectively. According to univariate and multivariate analysis, incidental diagnosis, maximum tumor diameter, tumor stage, lymph node and distant metastasis, TNM stage, and histological grade were significantly correlated with overall survival, but histological grade was the only factor confirmed as an independent prognostic factor for long-term survival of GEP-NEN.

GEP-NEN, with an increasing trend in incidence, occurred most frequently in the pancreas. Nonfunctional tumors with nonspecific symptoms comprised the majority of cases. The main treatment was surgical resection. Histological grade was confirmed as the only independent prognostic factor.
Computed tomographic findings of chest injuries following cardiopulmonary resuscitation
Authors: Jang Seo Jin , Cha Yoon Ki , Kim Jeung Sook , Do Han Ho , Bak So Hyeon , Kwack Won Gun
Published: August 2020

Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.

We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.

Lung contusions were found in all of the patients (mean LCS: 22, range: 5–47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86–15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.

The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.
Relationship between chemotherapy-induced adverse reactions and health-related quality of life in patients with breast cancer
Authors: Prieto-Callejero Blanca , Rivera Francisco , Fagundo-Rivera Javier , Romero Adolfo , Romero-Martín Macarena , Gómez-Salgado Juan , Ruiz-Frutos Carlos
Published: August 2020

Background and objectives:

Chemotherapy does not only affect cancer cells; it also affects, to a greater or lesser degree, all other cells in the body. This toxicity should be assessed according to its severity, frequency, and duration, taking into account objective and subjective dimensions in its assessment. This assessment is a highly relevant aspect when providing care to chemotherapy patients, mainly due to the impact of the treatment on the patient's quality of life, as well as the vital risk it may imply under certain circumstances. For all this, the objective of this study was to assess the relationship between chemotherapy-associated adverse reactions and health-related quality of life in breast cancer patients.

Materials and methods:

With this purpose, a descriptive cross-sectional study was developed on 110 breast cancer patients who were treated with docetaxel, epirubicin, and cyclophosphamide.

Results:

It is worth highlighting the negative effect of nausea, dysgeusia, peripheral neuropathy, loss of appetite, myalgia, and peripheral edema on the quality of life. Likewise, it is worth mentioning peripheral neuropathy as the toxicity that affects a greater number of quality-of-life indicators.

Conclusions:

To sum up, it would be necessary to make health professionals aware of the importance of chemotherapy-associated adverse reactions.
Peptic ulcer does not increase the risk of dementia
Authors: Choi Hyo Geun , Soh Jae Seung , Lim Jae Sung , Sim Song Yong , Jung Yoon Jung , Lee Suk Woo
Published: August 2020

Studies have shown that peptic ulcer disease (PUD) increases the risk of dementia via the mechanism of systemic inflammation. We examined the association between PUD and the risk of dementia using a population-based national sample cohort from South Korea.

Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with dementia (n = 11,434) and for 1:4 matched control participants (n = 45,736) and then analyzed the previous histories of PUD from 2002 to 2013 using conditional logistic regression analyses. The controls were matched to the patients according to age, sex, income, region of residence, and past medical history. Subgroup analyses were performed based on age and sex.

There was no statistically significant difference in the incidence of PUD between the dementia and control groups (18.0% vs 17.4%, P = .107). The adjusted odds ratio (OR) for PUD was 0.92 (95% confidence interval [CI] = 0.88–0.97, P = .002). In the subgroup analysis based on age, the adjusted ORs for PUD were 0.93 (95% CI = 0.88–0.99) in the <80-year-old group and 0.90 (95% CI = 0.82–1.00) in the ≥80-year-old group (each P < .05). In the subgroup analysis based on sex, the adjusted ORs for PUD were 0.89 (95% CI = 0.81–0.97; P < .05) in men and 0.94 (95% CI = 0.89–1.00; P = .06) in women.

PUD does not increase the risk of dementia at any age or in either sex after adjusting for age and the history of hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, and depression.
Myopathy is a Risk Factor for Poor Prognosis of Patients with Systemic Sclerosis
Authors: Zhou Meiju , Jiang Lichun , Nie Liuyan , Chen Ting , Zhang Ting , Sun Wenjia , Sutikno Joshua , Du Yan , Xue Jing
Published: August 2020

To compare clinical characteristics and identify long-term outcomes of Chinese patients with systemic sclerosis (SSc) with and without muscle involvement.

We retrospectively investigated the medical records, laboratory results, and computed tomography images of 204 consecutive SSc patients. Kaplan–Meier analysis was performed to determine survival rates. Patients were allocated into groups with and without myopathy.

The prevalence of myopathy was 21.6%. The myopathy group was more likely to develop diffuse cutaneous involvement (90.9% vs 56%, P = .006), interstitial lung disease (90% vs 56%, P < .001), digestive system involvement (56.7% vs 29.3%, P = .001), pulmonary hypertension (29.5% vs 10.5%, P = .004), and pericardial effusion (25% vs. 10%, P = .019). Patients with myopathy had lower single-breath diffusing capacity of the lung for carbon oxide (46.5 ± 11.1 vs 57.1 ± 13.4, P < .001).Further, the myopathy group has similar results in interstitial lung disease associated higher resolution computed tomography score (186.8 ± 64.5 vs 152.3 ± 45.5, P = .037), Valentini score for disease activity (3.4 ± 0.9 vs 2.0 ± 0.9, P < .001) and modified Rodnan total skin score (19.4 ± 6.1 vs 15.1 ± 7.7, P 
= .002), compared with non-myopathy group. Kaplan–Meier survival analysis revealed decreased overall survival rate of the myopathy group (P = .028).

SSc Patients with myopathy had more severe clinical manifestations and higher disease activity compared with those without, which affected survival rates and indicated worse prognosis.
Triphasic waves in electroencephalogram as a possible early marker of carcinomatous meningitis: a case report
Authors: Liu Chang , Cheng Shihuan , Ma Yue , Liu Caiyun , Lv Yudan
Published: August 2020

Rationale:

Carcinomatous meningitis is a rare neurological complication. This condition is difficult to diagnose, and misdiagnosis is common because the clinical manifestations are variable. Cerebrospinal fluid (CSF) cytology is the gold standard for diagnosis. Repeated lumbar puncture is required because of the low positive rate. Our case showed triphasic waves (TWs) in an electroencephalogram (EEG) before cancer cells were detected in cytology. We report this case to demonstrate that TWs in EEG may be a prognostic marker in patients with carcinomatous meningitis.

Patient concerns:

A 76-year-old Chinese male displayed incremental headache, nausea, emesis, and intermittent fever for 2 months. A routine scalp EEG showed mild slow background activity. The CSF analysis demonstrated a slight increase in protein, and the white blood cell count was in the normal range. Cytology did not show any atypical cells. Viral meningitis was considered for the first time.

Diagnosis:

After admission, a long-term EEG was performed because of his fever and mild abnormalities in the routine EEG. The second EEG showed asymmetric TWs in the frontal brain regions. Lung adenocarcinoma was found after systemic investigation. Finally, the patient was diagnosed with carcinomatous meningitis based on repeated CSF cytology.

Interventions:

The patient received systemic chemotherapy in the Department of Oncology.

Outcomes:

The patient was followed up monthly, and he was lost to follow-up in the sixth month after carcinomatous meningitis was diagnosed.

Lessons:

It is difficult to make a diagnosis in the early stage of carcinomatous meningitis because the clinical manifestations lack specificity. Repeated lumbar puncture is time consuming and is painful for the patients. In our case, TWs in EEG were detected before cancer cells were found in cytology. EEG should be performed when carcinomatous meningitis is under consideration.
Primary breast diffuse large B-cell lymphoma in a patient with systemic lupus erythematosus
Authors: Shen Feifei , Li Gang , Jiang Huifeng , Zhao Shupeng , Qi Fengjie
Published: August 2020

Rationale:

Pilot studies have reported that patients with systemic lupus erythematosus (SLE) appear more likely to develop into neoplasia, especially lymphatic hyperplasia diseases. To our knowledge, this is the first case report of the concomitant onset of SLE and primary breast diffuse large B-cell lymphoma (PB-DLBCL).

Patient concerns:

We reported an unusual case of the occurrence of primary breast diffuse large B-cell lymphoma in a 25-year-old female patient who had been diagnosed with SLE and treated with immunosuppressive drugs for about 4 years. She presented a 7-week history of a painless mass above the left breast and no history suggestive of any nipple discharge, fever, and weight loss.

Diagnosis:

Ultrasonography of the breast showed that there was 1 mass in the left breast. After breast mass surgical resection, histopathological examinations were performed and revealed that it was primary breast diffuse large B-cell lymphoma.

Interventions:

Treatment strategy with vincristine and dexamethasone was used to improve symptoms. However, the patient's renal function deteriorated and the blood potassium rose continuously and she and their family members refused the follow-up treatments.

Outcomes:

The patient died 8 months after she was discharged from the hospital.

Lessons:

PB-DLBCL is a rare occurrence in SLE patients. Therefore, a careful examination is very important in SLE cohort, as activity of the disease and malignancy may mimic each other. Meanwhile, when symptoms cannot be explained or insensitive to treatment, the occurrence of malignant tumors must be highly considered.
Social cognition in multiple sclerosis and its subtypes
Authors: Lin XiaoGuang , Zhang XueLing , Liu QinQin , Zhao PanWen , Zhong JianGuo , Pan PingLei , Wang GenDi , Yi ZhongQuan
Published: August 2020

Background:

Multiple sclerosis (MS) is an inflammatory and degenerative neurological disorder of the central nervous system. Cognitive impairment is frequent in MS patients, which not only includes deficits in abilities assessed by traditional neuropsychological batteries, but also often features impairments in social cognition (including theory of mind and facial emotion recognition). Recently, numerous studies have assessed social cognition performance in MS. However, there have been inconsistent findings. Besides, it is not clear how social cognitive abilities are affected in MS subtypes. The aim of this study is to conduct a meta-analysis to characterize social cognition performance in MS and its subtypes (clinically isolated syndrome, relapsing-remitting MS, progressive primary MS, and secondary progressive MS).

Methods:

Literature sources will be divided into 2 sections: electronic sources and manual sources. A systematic literature search will be performed for eligible studies published up to June 10, 2020 in 3 international databases (Embase, PubMed, and Web of Science). In addition, manual sources will be searched, such as the references of all included studies. Two researchers will independently conduct the work such as article retrieval, screening, quality evaluation, data collection. Meta-analysis will be conducted using Stata 15.0 software.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusions:

This meta-analysis will provide a high-quality synthesis from existing evidence for social cognition performance in MS and its subtypes.

PROSPERO registration number:

INPLASY202070028.
Dopa-responsive dystonia caused by tyrosine hydroxylase deficiency
Authors: Dong Han-Yu , Feng Jun-Yan , Yue Xiao-Jing , Shan Ling , Jia Fei-Yong
Published: August 2020

Rational:

Tyrosine hydroxylase deficiency (THD) is a rare cause of dopa-responsive dystonia (DRD). Although the symptoms of DRD may be improved by treatment with L-dopa, the low morbidity of THD can lead to its misdiagnosis. Thus, it is important for physicians to be aware of THD as a cause of DRD.

Patient concerns:

We report 3 cases of THD. A 5-year-old boy with DRD was diagnosed with THD and found to have compound heterozygous mutations of the TH gene, including TH:c.647G>C from his mother and TH:c.646G>A from his father. Two female siblings also were found to have TH:c.698G>A from their mother and TH:c.710T>C from their father. The younger daughter, at age 3.5 years, was diagnosed with DRD caused by THD, and then the diagnosis of the older daughter, at age 11 years, was changed from cerebral palsy to DRD caused by THD.

Diagnosis:

The diagnosis of dopa-responsive dystonia caused by tyrosine hydroxylase deficiency was determined by whole exome sequencing.

Intervention:

They all treated with low dose levodopa and benserazide tablets.

Outcomes:

The boy had a very good therapeutic effect, and he could walk very well by the second day of treatment. The younger sister of the siblings had a partial therapeutic effect, but her elder sister was only little effective with a milder improvement of dystonia and improvement of myodynamia.

Conclusion:

The characteristics of THD are heterogeneous, and its phenotypes are classified as type A or type B according to increasing severity. Generally, L-dopa has a good therapeutic effect in cases with type A phenotypes. We reviewed 87 cases of reported in the literature and found that c.698G>A and c.707T>C are hot spot mutations. Changes on cerebral magnetic resonance imaging were nonspecific. Analysis of neurotransmitter levels in cerebrospinal fluid is an invasive means of achieving a biochemical diagnosis.
A maxillary center incisor with three independent roots and three root canals
Authors: Wang Jia , Zhang Wenyi , Zhou Lei
Published: August 2020

Rationale:

Three root canals (mesiobuccal, distobuccal and palatal) are rarely found (frequency <1%) in the maxillary central incisor even though root canal morphology in maxillary premolars is highly variable. Therefore, research papers showed that dentists can easily miss the root canals in diagnosis and inflammatory diffusion; which could cause unsuccessful root canal treatment leading to various possible infections and no change in original inflammations. In this report, the diagnose and clinical management of an unusual case of a maxillary center incisor with three independent roots and three root canals is presented, along with a demonstration of using CBCT (Cone Beam Computed Tomography) and collaborate with other departments to successfully accomplish an accurate diagnosis of the morphology and quantity of the root canal system.

Patient concerns:

The patient was referred to clinic for his repeatedly abscessed in the gums of the left upper central incisor.

Diagnoses:

Based on clinical and radiographic evidences, the patient was tentatively diagnosed with a chronic periapical periodontitis for #21 tooth.

Interventions:

The patient was performed with the conventional root canal treatment and then clinical observed.

Outcomes:

At the second visit after 7 days, the patient was not sensitive to percussion. After operation for 3 months, and found that the sinus opening had not healed. Then, the patient was undergone with the periodontal flap surgery to remove root infection for 2 weeks.

Lessons:

From this clinical case, the lesson learned is that the previous clinical experiences cannot be used to make judgments or decisions; it requires specific analysis from the information gathered through CBCT(Cone Beam Computed Tomography)and the cooperation between different departments to come up with a responsible decision. In any stomatological hospitals, due to the large number of departments and the strong specialized focuses for each department; it is very important to encourage and support the cooperation between the departments, to limit any judgment bias due to lack of knowledge and maximize each department's strengths.
Wuzi Yanzong Pill for the treatment of male infertility
Authors: Yong Shanshan , Yang Yali , Li Fuhao , Yao Hangyu , Yang Fang , Chang Degui
Published: August 2020

Background:

The incidence of male infertility is increasing worldwide, and has become an important problem that plagues many married couples. Half of the infertility cases have induced by male infertility. Wuzi Yanzong Pill is a traditional Chinese herbal formula used in treating spermatorrhea, premature ejaculation, erectile dysfunction, lumbago and male sterility widely. Therefore, in this systematic review, we design to evaluate the effectiveness and safety of Wuzi-Yanzong Pill for the treatment of male infertility.

Methods:

The English and Chinese literature published before June 30, 2020 will be searched in PubMed, EMBASE, Cochrane library, and Chinese literature in China National Knowledge Infrastructure, Chinese biomedical document service system, VIP Chinese Science and Technology Journal Database, WANFANG data. All related randomized controlled trials that meet the eligibility criteria will be included and other studies will be excluded. We will search literature with text keywords “male infertility” or “sperm” or “semen” and “Wuzi Yanzong Pill” or “Wuziyangzong” or “WZYZ”. Progressive motility, sperm concentration, sperm morphology, sperm viability, sperm DNA fragmentation, sperm number per ejaculate, pregnancy rates will be evaluated. RevMan 5.3 and Stata 14.0 will be used to conduct this systematic review. The preferred reporting items for systematic reviews and meta-analysis protocols statement is followed in this protocol and the PRISMA statement will be followed in the completed systematic review.

Conclusion:

The efficacy and safety of Wuzi Yanzong Pill in the treatment of male infertility will be e evaluated. The results of this review may provide some help for the clinician's decision.
A clinical study of Yiqi Huayu Jiedu decoction reducing the risk of postoperative gastric cancer recurrence and metastasis
Authors: Hu Yue , Pan Xiaoting , Nie Mengjun , Liu Yuanjie , Zou Xi , Liu Shenlin , Liu Qin , Wang Ruiping , Zhang Li
Published: August 2020

Background:

Gastric cancer is a common gastrointestinal tumor, seriously threatening human health. Radical surgery is the preferred treatment for gastric cancer. However, due to the late diagnosis and postoperative recurrence and metastasis, the prognosis is dismal. In China, traditional Chinese medicine (TCM) has been used to treat gastric cancer for many years. The purpose of this study is to explore the efficacy and safety of Yiqi Huayu Jiedu decoction in the treatment of postoperative gastric caner.

Methods/design:

226 eligibility patients altogether will be randomly allocated to the treatment group and the control group at a ratio of 1:1. After enrollment, every patients will obtain 6 months of treatment, as well as 2 years of follow-up. At the end of this study, primary outcomes including 1-year progression-free survival rate, 2-year progression-free survival rate and disease-free survival, secondary outcomes containing tumor markers, TCM syndrome points, quality of life scale, imageological examination and the safety indicators will be assessed.

Discussion:

This study will provide the evidence-based evidence for the efficacy of Yiqi Huayu Jiedu decoction reducing the risk of postoperative gastric cancer recurrence and metastasis, which will be beneficial to form the therapeutic regimen in postoperative gastric cancer with integrated TCM and Western medicine.

Trail registration:

ChiCTR2000032802
Mining prognostic factors of extensive-stage small-cell lung cancer patients using nomogram model
Authors: Gao Hongxiang , Dang Yazheng , Qi Tao , Huang Shigao , Zhang Xiaozhi
Published: August 2020

This study is to establish the nomogram model and provide clinical therapy decision-making for extensive-stage small-cell lung cancer (ES-SCLC) patients with different metastatic sites using the Surveillance, Epidemiology, and End Results (SEER) Program.

A total of 10,025 patients of ES-SCLC with metastasis from January 2010 to December 2016 were enrolled from the SEER database. All samples were randomly divided into a derivation cohort and a validation cohort, and the derivation cohort was divided into 6 groups by different metastatic sites: bone, liver, lung, brain, multiple organs, and other organs. Using Cox proportional hazards models to analyze candidate prognostic factors, screening out the independent prognostic factors to establish the nomogram. Compare the different models by Net reclassification improvement and integrated discrimination improvement. Concordance index (C-index) and the calibration curve were used to verify the prediction efficiency of the nomogram in the derivation cohort and validation cohort.

In the derivation cohort, the median overall survival was 7 months. The overall survival rates at 6-month, 1-year, and 2-year were 55.07%, 24.61%, and 7.56%, respectively. The median survival time was 10, 8, 7, 9, 7, and 6 months for the 6 groups of different metastatic sites: other, bone, liver, lung, brain, and multiple organs, respectively. Age, sex, race, T, N, distant metastatic site, and chemotherapy were contained in the final nomogram prognostic model. The C-index was 0.6569777 in the derivation cohort and 0.8386301 in the validation cohort.

The survival time of ES-SCLC patients with different metastatic sites was significantly different. The nomogram can effectively predict the prognosis of individuals and provide a basis for clinical decision-making.
What factors affect the methodological and reporting quality of clinical practice guidelines for osteoporosis? Protocol for a systematic review
Authors: Fang Peng-Zhong , Chen Ya-Min , Chen Jin-Lei , Sun Jun-Hao , Tan Jian-Shi , Wang Rui-Rui , Wang Xin
Published: August 2020

Background:

Osteoporosis is a disease with a high prevalence and low treatment rate, which poses a serious threat to the lives of patients and brings a heavy economic burden. Clinical practice guidelines (CPGs) provide vital guidance for disease management. Up to now, different countries, regions, and organizations have issued a certain number of CPGs for osteoporosis, but the recommendations in different guidelines are inconsistent. This protocol plans to evaluate the quality of the CPGs for osteoporosis and then make a comparative analysis of the recommendations in the CPGs.

Methods:

Several databases including PubMed, Web of Science, Embase, and Cochrane Library, as well as the official website of relevant organizations will be searched. Screen and data extraction will be performed by two reviewers independently, and the third reviewer help to resolve the divergence between them. Using the AGREE II instrument and RIGHT checklist to assess the methodological and reporting quality of the CPGs. The extracted recommendations, including but not limited to screening, diagnosis, evaluation and treatment, will be summarized and analyzed, and the results will be presented in tabular form. Bubble charts will be used to show quality differences between CPGs and to describe the correlation between methodological and reporting quality through regression analysis. Excel, EndnoteX9 and SPSS 25.0 will be used.

Result:

To evaluate the advantages and disadvantages of the existing CPGs of osteoporosis and analyze the similarities and differences between the recommendations, the results will be published in a peer-reviewed journal.

Conclusion:

This study will provide systematic evidence for existing CPGs of osteoporosis and to provide a reference for CPGs users.

Protocol Registration:

INPLASY 202070031.
The operation training for magnetically controlled capsule endoscopy
Authors: Hu Jinlong , yunpeng Huang , Wang Shupeng , Sun Siyu
Published: August 2020

Background and aim

Magnetically controlled capsule endoscopy (MCE) is a safe, noninvasive examination and has a diagnostic accuracy similar to that of standard gastroscopy. Now, MCE is widely used in the clinical practice. However, there is no studies about MCE training. This study aims to report the operation training course of MCE.

Methods

The MCE training data of trainees without gastroscopy experience was reviewed. The characteristics of trainees, training course, training time and training results were recorded.

Results

The MCE training data of five technical people were included in the present study. All participants were females with mean age of 32-years-old (range 30–34 years). All the participants finished the training course in 4 days. We reviewed the data of the first 10 MCE examination performed by the participant. Three participants could finish the whole stomach observation in all 10 patients (10/10). Two participants could finish the whole stomach observation in nine patients (9/10).

Conclusion

After the systematic training course, technical staff can be trained for MCE operation. Further studies should be conducted to observe the learning curve of MCE operation.
Paediatric inflammatory bowel disease in India: a prospective multicentre study
Authors: Srivastava Anshu , Sathiyasekharan Malathi , Jagadisan Barath , Bolia Rishi , Peethambaran Maya , Mammayil Geetha , Acharya Bhaswati , Malik Rohan , Sankaranarayanan Srinivas , Biradar Vishnu , Malhotra Smita , Philip Mathew , Poddar Ujjal , Yachha Surender Kumar
Published: August 2020

Background

Paediatric inflammatory bowel disease (PIBD) is increasing across the world. However, information from India is sparse. This multicentre study evaluated the demographics, clinical phenotype and outcome of PIBD from India.

Methods

Data of children (≤18 years) with PIBD were collected using a proforma containing details of demographics, clinical profile, extraintestinal manifestations (EIM), investigations, disease extent and treatment.

Results

Three hundred twenty-five children [Crohn’s disease: 65.2%, ulcerative colitis: 28.0%, IBD unclassified (IBDU): 6.7%, median age at diagnosis: 11 (interquartile range 6.3) years] were enrolled. 6.9% children had family history of IBD. Pancolitis (E4) was predominant in ulcerative colitis (57.8%) and ileocolonic (L3, 55.7%) in Crohn’s disease. Perianal disease was present in 10.9% and growth failure in 20.9% of Crohn’s disease cases. Steroids were the initial therapy in 84.2%, 5-amino salicylic acid in 67.3% and exclusive enteral nutrition (EEN) in 1.3% cases. Overall, immunomodulators and biologics were given to 84.3 and 17.9% cases, respectively, and 2.9% cases underwent surgery. Very early onset IBD (VEOIBD) was seen in 60 (19.2%) children. IBDU was commoner in the VEOIBD than the older-PIBD (18/60 vs 4/253; P < 0.001). VEOIBD-Crohn’s disease patients more often had isolated colonic disease than the older Crohn’s disease (45.4% vs 11.8%; P < 0.001). Prevalence of perianal disease, EIM, therapeutic requirements and outcome were not different between VEOIBD and older-PIBD.

Conclusion

Disease location and phenotype of PIBD in Indian children is similar to the children from the west. However, the therapeutic options of EEN, biologics and surgery are underutilized. VEOIBD accounted for 19.2% of PIBD.
Negative 11C-choline PET/computed tomography imaging in restaging of patients with prostate cancer with serum prostate-specific antigen values >20 ng/mL
Authors: Telo Silvi , Fanti Stefano , Nanni Cristina , Lambertini Alessandro , Picchio Maria , Gianolli Luigi , Schiavina Riccardo , Bianchi Lorenzo , Briganti Alberto , Mapelli Paola , Castellucci Paolo , Farolfi Andrea
Published: August 2020

Objective

Several studies have reported about the performance of 11C-choline-PET/computed tomography (CT) (choline) in patients with biochemical recurrent (BCR) prostate cancer, but there is a lack of information regarding negative choline in the same clinical setting. Our aim was to retrospectively analyse negative choline in a cohort of BCR-patients with high prostate-specific antigen (PSA).

Methods and Results

We retrospectively analysed all choline-scans performed at two high-volume imaging centres between 2005 and 2018, selecting those of interest according to the following inclusion criteria: (1) proven prostate cancer treated either with radical prostatectomy or primary external beam radiation therapy (EBRT), (2) BCR after radical prostatectomy or EBRT, (3) PSA serum values >20 ng/mL at the time of scan and (4) scan reported as negative for active disease. Overall, among 5792 scans performed for BCR-prostate cancer, 14 matched the inclusion criteria and were classified as follows: 5/14(36%) inaccurate reports, 3/14(21%) questionable underestimation of positive findings, originally described as unclear, 6/14(43%) negatives. Choline showed a high detection rate in BCR-prostate cancer patients with PSA >20 ng/mL.

Conclusions

Although negative reports can be found in this clinical setting, in our review various disease-relevant findings were identified in more than half of the cases originally reported as negative warranting a double reading in such cases to avoid false-negative reports.
Semiquantitative assessment of fluorodeoxyglucose uptake in primary tumours on dynamic PET/computed tomography for lymph node metastasis evaluation in patients with lung cancer: a prospective study
Authors: Yamanaka Moriaki , Shinya Takayoshi , Otomi Yoichi , Kubo Michiko , Arai Yuta , Toba Hiroaki , Bando Yoshimi , Otsuka Hideki , Harada Masafumi
Published: August 2020

Objective

To semiquantitatively estimate fluorine-18-fluorodeoxyglucose (FDG) uptake in primary lung cancer cells using dynamic and dual-time-point (DTP) PET/computed tomography (PET/CT) to obtain a diagnostic index for lymph node metastasis.

Methods

Forty-five patients with lung cancer underwent dynamic and DTP PET/CT examinations. All primary lesions and lymph node metastases were evaluated pathologically. At each time phase, we assessed the maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumours. We investigated the relationship between semiquantitative index and the presence of lymph node metastasis for each case and for all cases satisfying indications for segmentectomy. In cases with lymph node metastasis, we assessed the SUVmax of pathologically proven metastatic lymph nodes and nonmetastatic lymph nodes in each dynamic phase for evaluating temporal change.

Results

Among 45 patients, 15 had 17 lymph node metastasis. SUVmax, MTV and TLG of primary tumours at each time phase were significantly associated with lymph node metastasis (P < 0.05). In receiver operating characteristic analysis, dynamic second and third phases showed high diagnostic ability for lymph node metastasis. The temporal change in SUVmax in the dynamic phase between primary tumours and metastatic lymph nodes were significantly different (P = 0.065). The temporal change in SUVmax was significantly lower in nonmetastatic lymph nodes than in primary tumours and metastatic lymph nodes (P < 0.0001).

Conclusions

Semiquantitative assessment of FDG uptake in dynamic second and third phases and the assessment of temporal changes in SUVmax on dynamic PET/CT scans were important predictors in diagnosing lymph node metastasis.
Placental transfer of the integrase strand inhibitors cabotegravir and bictegravir in the ex-vivo human cotyledon perfusion model
Authors: Pencolé Lucile , Lê Minh P. , Bouchet-Crivat Florian , Duro Dominique , Peytavin Gilles , Mandelbrot Laurent
Published: August 2020

Data on placental transfer is lacking for the recent HIV integrase inhibitors, bictegravir and cabotegravir, although their future use in pregnancy is to be expected. The objective of this study was to determine their transplacental pharmacokinetics. Maternal-to-fetal transfer was investigated using the open-circuit ex-vivo dually perfused human cotyledon model. Cabotegravir or bictegravir was added to a maternal perfusate containing 2 g/l of human albumin and antipyrine, a marker to validate the cotyledon's viability, and cotyledons were dually perfused for up to 90 min. For cabotegravir, in five experiments, the median (IQR 25–75) concentrations in the maternal and in the fetal compartments were, respectively, 550 ng/ml (344–788) and 48 ng/ml (37–54), with a maternal-to-fetal ratio of 10% (5–16) and a clearance index (in comparison with antipyrine transfer) of 22% (19–28). The median cotyledon accumulation index was 10% (2–21). For bictegravir, in six experiments, the median (IQR 25–75) concentrations in the maternal and in the fetal compartments were, respectively, 1650 ng/ml (1455–1960) and 126 ng/ml (112–142), with a maternal-to-fetal ratio of 7% (6–9.5) and a clearance index (in comparison with antipyrine transfer) of 21% (17–29). The median cotyledon accumulation index was 4% (3–5). Placental transfer of cabotegravir and bictegravir were low. This may not only limit the potential for fetal toxicities but also be a limit to their usefulness at the time of labor and delivery to reduce the risk of vertical HIV transmission. The safety and efficacy of these new integrase inhibitors in pregnancy require more investigation.