bluuebunny/crossref_metadata_2025 huggingface dataset:
Heamatological malignancies in giant cell arteritis: a French population-based study
Authors: Greigert Hélène , Mounier Morgane , Arnould Louis , Creuzot-Garcher Catherine , Ramon André , Martin Laurent , Tarris Georges , Ponnelle Tibor , Audia Sylvain , Bonnotte Bernard , Maynadie Marc , Samson Maxime
Published: March 2021

Objectives

An increased risk of haematological malignancies (HM) has been reported in GCA patients. Our study aimed to investigate the incidence and the type of HM occurring in GCA.

Methods

All patients with GCA and HM living in Côte d’Or (France) were identified by crossing data from the RHEMCO (Registre des Hémopathies Malignes de Côte d’Or) and those having a positive temporal artery biopsy between 1 January 2001 and 31 December 2018.

Results

Among 276 biopsy-proven GCA patients, 14 HM were identified in 12 patients (4.3%). In comparison with the general population aged >50 y, the incidence of myeloid HM and myeloproliferative syndromes were increased in GCA patients [standardized incidence ratios (SIR) = 2.71 and 5.16, respectively], with a specific increase in men with GCA (SIR = 4.82 and 9.04, respectively) but not in women. In addition, the study of SIR depending on the chronology between GCA and HM diagnoses suggests that there was an increased risk of developing GCA in men but not in women, after a diagnosis of myeloid HM (SIR = 9.56), especially if it was a MPS (SIR = 17.56).

Conclusions

Our study shows a particular epidemiology of HM in GCA patients, which is characterized by an increased incidence of myeloid HM, especially MPS, in male GCA patients. The chronology of the diagnoses of GCA and HM raises the hypothesis that clonal hematopoiesis may be implicated in some cases of GCA.
Efficacy of telehealth acceptance and commitment therapy for weight loss: a pilot randomized clinical trial
Authors: Bricker Jonathan B , Mull Kristin E , Sullivan Brianna M , Forman Evan M
Published: March 2021

Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n = 53) with standard behavioral therapy (SBT; n = 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15–20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reported weight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N = 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N = 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N = 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reported weight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N = 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.
Thrombocytopenia
Authors: Collins Yoder Angela Smith , Hines Cheryl B.
Published: March 2021

Background

There are 2 classification of strokes: ischemic, if caused by an arterial occlusion from a clot or obstruction by atherosclerosis, and hemorrhagic, if caused by the rupture of a vessel and subsequent bleeding. Each type of stroke is influenced by platelet counts and platelet function. The intention of this article is to discuss the role of the platelet in the pathophysiology of acute stroke processes. This serves as a prelude to discussing these processes as disrupted with thrombocytopenia (low platelet counts). Platelets initiate clot formation and obstruct blood flow through the creation of a platelet plug. They also extend the penumbra in ischemic and hemorrhagic strokes. Thrombocytopenia can be a causal factor in an ischemic stroke, a risk factor for hemorrhagic stroke, and a risk factor for hemorrhagic stroke conversion.

Methods

The aims of this study were to review 1 case study that illustrates the pivotal role of the platelet in strokes and to review the aspect that was impacted by autoimmune thrombocytopenia.

Discussion

Thrombocytopenia is a hematologic disorder not often included in stroke care discussions. Thrombocytopenia sets up strokes to occur and, paradoxically, may also set the patient up for bleeding complications in the brain or groin.

Conclusion

Acknowledging the impact of both platelet and thrombocytopenia on stroke causation, stroke interventions, and outcomes is a pivotal aspect of comprehensive stroke care. Platelet function processes are impactful in each point of the continuum of stroke care, prevention, intervention, and discharge.
Voriconazole Sequestration During Extracorporeal Membrane Oxygenation for Invasive Lung Aspergillosis: A Case Report
Authors: Mathieu Alexandre , Thiboutot ZoÉ , Ferreira Victor , Benoit Patrick , Grandjean Lapierre Simon , HÉtu Pierre-Olivier , Halwagi Antoine
Published: March 2021

The increasing use of extracorporeal membrane oxygenation (ECMO) in critical care introduces new challenges with medication dosing. Voriconazole, a commonly used antifungal and the first-choice agent for the treatment of invasive aspergillosis, is a poorly water-soluble and highly protein-bound drug. Significant sequestration in ECMO circuits can be expected; however, no specific dosing recommendations are available. We report on the therapeutic drug monitoring and clinical evolution of a patient treated with voriconazole for invasive pulmonary aspergillosis while receiving ECMO therapy. Voriconazole trough levels were persistently low (<1 µg/mL) after initiation of ECMO despite additional loading doses and dose increases. Voriconazole dose had to be increased to 6.5 mg/kg three times daily to obtain therapeutic trough levels. The inability to achieve therapeutic levels of voriconazole for a prolonged period (a minimum of 9 days) while undergoing ECMO therapy is believed to have been a significant contributing factor in the patient’s fatal outcome. Therapeutic trough levels of voriconazole cannot be guaranteed with standard dosing in patients undergoing ECMO and much higher doses may be necessary. Empirical use of higher doses and/or combination therapy may be reasonable and frequent therapeutic drug monitoring is mandatory.
Hematopoietic stem cell transplantation in an infant with dedicator of cytokinesis 8 (DOCK8) deficiency associated with systemic lupus erythematosus
Authors: Seo Euri , Lee Beom Hee , Lee Joo Hoon , Park Young Seo , Im Ho Joon , Lee Jina
Published: March 2021

Introduction:

DOCK8 deficiency is a primary immunodeficiency characterized by recurrent infections, severe allergic disease, and autoimmunity. Here, we report a patient with DOCK8 deficiency that was initially presented as systemic lupus erythematosus (SLE) without recurrent infections and treated with hematopoietic stem cell transplantation (HSCT).

Patient concerns:

A 16-month-old boy with a previous history of eczema developed high fever and hand and foot swelling. Over time, multiple purpura, oral ulcers, and oliguria developed with a persistent fever. His laboratory findings showed anemia, thrombocytopenia, and coagulopathy with a high level of C-reactive protein (CRP). No definite pathogens were identified. The complement fractions C3, C4, and CH50 were low. Autoantibodies including antinuclear antibody (ANA) and anti-ds DNA antibody were positive. He definitively satisfied the 2015 ACR/SLICC revised criteria for the diagnosis of SLE (7 points out of 16); therefore, he was treated with a steroid. Lupus nephritis was confirmed by renal biopsy later. Considering the early-onset SLE, partial exome sequencing was performed.

Diagnosis:

One heterozygous missense variant, c.5536A>G (p.Lys1846Glu), which was inherited from his father, and heterozygous deletion of exon 1 to 8 inherited from his mother were found. Through the results of the genetic testing, the patient was confirmed to have DOCK8 deficiency.

Interventions:

At the age of 28 months, he received haploidentical HSCT from his mother as a donor.

Outcomes:

Laboratory findings including complement fractions C3, C4, CH50, anti-ds DNA antibody, and the ANA became normal after HSCT. Currently, at 12 months post-HSCT, he is doing well, without any autoimmune features or infections.

Conclusions:

DOCK8 deficiency can be presented as autoimmune disease such as SLE. Encountering a child diagnosed with SLE at a very young age, pediatricians should consider immunodeficiency syndrome including DOCK8 deficiency.
Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder
Authors: Song Chengjun , Song Chengwei , Li Chengwen
Published: March 2021

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.

Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.

More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up.

ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.
Clinical Yi-guan decoction for liver cirrhosis
Authors: Hu Xingyao , Shang Guangbin , Zhang Jie , Chen Zhong , Fu Liu , Li Jun , Lu Xiaonan
Published: March 2021

Background:

At present, Liver Cirrhosis (LC) is common in most later liver and gallbladder diseases that its morbidity and mortality seriously affect human health. The limitation and effectiveness of western medicine on LC have become a huge clinical challenge. However, a large number of clinical studies have shown that Yi-guan decoction has become a complementary treatment for LC. Therefore, this systematic review will aim to explore the safety and feasibility of Yi-guan decoction in the treatment of LC.

Methods:

We will conduct a comprehensive literature search in Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Wang Fang Database, Chinese Scientific Journal Database from inception to December 2020 without any language restriction, In addition, relevant literature will be searched manually. The main subject terms searched: “Yi-guan decoction” “cirrhosis” “LC”. Data entry will be performed by 2 researchers separately. Primary outcomes will be concluded: Liver function indicators: Total bilirubin, Alanine transaminase, Aspartate aminotransferase, etc. Secondary outcome indicators: Total effective rate, Nutrition index, Survival analysis, Adverse events; All randomized controlled trials collected in this study will be evaluated and rated using the Cochrane risk-of-biasassessment tool. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be conducted between the studies, P < .1 and I2 > 50% are the thresholds for the tests. Using solid effect model or random effect model will be based on its heterogeneity value.

Results:

This systematic review provides a theoretical basis for Yi-guan decoction to treat LC, we will report this result soon.

Conclusion:

This study will explore Yi-guan decoction can will be used as one of the non drug therapies to prevent or treat LC.

Trial registration number:

INPLASY2020120114.
Effect of auricular point pressing therapy on hyperplasia of mammary glands
Authors: Ma Mengjie , Zhang Liuqiao , Wang Xiangli
Published: March 2021

Background:

In recent years, with the accelerated pace of life, diet, environmental problems occur frequently. External factors are easily to cause endocrine disorders and hormone sensitivity of breast tissue, which can lead to mammary hyperplasia. The incidence rate of hyperplasia of mammary glands is increasing year by year, and the age of onset is also getting lower and lower. If not treated in time, there is a crisis of breast cancer.

Clinical studies have found that auricular point pressing therapy is widely used in clinical treatment of mammary hyperplasia recently, but the efficacy of massage in the treatment of mammary hyperplasia has not been systematically reviewed. The purpose of this study is to explore the efficacy, safety and effectiveness of auricular point pressing therapy in the treatment of hyperplasia of mammary glands.

Methods:

We will search PubMed, Web of Science, Cochrane Library, EMBASE, Wan fang Database, Chinese Scientific Journal Database, CNKI, VIP, and Chinese Biomedical Literature Database. The retrieval date was January 10, 2021. RevMan 5.3 software was used to evaluate the quality and risk of included studies. The efficacy, recurrence rate, and symptom score of breast hyperplasia were analyzed, and the results were observed and measured.

Results:

This study will be from the clinical efficiency, improvement rate, pain symptoms disappear rate, tumor size improvement rate, and other aspects of the existing evidence for a high quality synthesis, as well as auricular point pressing therapy adverse events.

Conclusion:

the conclusion of this review will provide the basis for judging whether auricular point pressing therapy is safe and effective in the treatment of hyperplasia of mammary glands.

Ethics and dissemination:

This systematic will evaluate the effectiveness and safety of auricular point pressing therapy in the treatment of hyperplasia of mammary glands. As all data used in this systematic review and meta-analysis have been published, ethical approval is not required for this review.

Protocol registration number:

INPLASY202110028.
Myeloid sarcoma of the pancreas
Authors: Wu Kangze , Zhang Xuzhao , Zhang Bo
Published: March 2021

Introduction:

Myeloid sarcoma (MS) is an extramedullary mass, consisting of myeloid blasts with or without maturation, which efface the normal tissue architecture. It occurs mainly in lymph nodes, skin and soft tissue, testis, bone, peritoneum, and gastrointestinal tract, but rarely in the pancreas. Because their clinical courses, treatments, and prognoses are quite different, it is crucially important to distinguish between MS and pancreatic cancer.

Patient concerns:

We herein report a rare case of acute myeloid leukemia (AML) which presented with a pancreatic mass that mimicked pancreatic cancer.

Diagnosis: The diagnosis of MS was established based on immunohistochemical (IHC) analysis and bone marrow examination which revealed neoplastic cells with CD34+/CD117+.

Interventions:

The patient was actively treated with chemotherapy.

Outcomes:

After 4 cycles of chemotherapy, the lesion in pancreas was significantly reduced, and the patient is still receiving further chemotherapy.

Conclusion:

When we encounter a patient suspected of pancreatic cancer with blood cell abnormalities and no significant increase in carbohydrate antigen 19-9 (CA19-9), we need to be aware of the possibility of pancreatic MS. Preoperative pathological biopsy and IHC are indispensable. Misdiagnosis is common if we rely solely on imaging.
Gender effect on eating habits of Nigerian school children
Authors: Obidoa Jaachimma Chioma , Onyechi Kay Chinonyelum Nwamaka , Chukwuone Chiamaka Adaobi , Dimelu Ifeoma Ngozi , Victor-Aigbodion Vera , Eseadi Chiedu , Chukwu Chinyere Loveth , Ejiofor Juliana Ngozi , Obande-Ogbuinya Nkiru Edith , Uba Mercy Benedette Ifeoma , Folorunsho Raphael Oluwasina Babalola , Oraelosi Charles Azubuike , Onuorah Anthonia Ekanibe
Published: March 2021

It is important to investigate children's eating habits based on different eating behaviors such as satiety responsiveness (SR), slowness in eating (SE), food fussiness (FF), food responsiveness (FR), enjoyment of food (EF), desire to drink (DD), emotional under-eating (EUE), and emotional over-eating (EOE). The main objective of this research was to investigate whether gender affects the eating habits of Nigerian school children.

A cross-sectional survey was conducted between March and June 2019. A total of 120 parents of school children participated in the study. The Child Eating Behavior Questionnaire (CEBQ) was used to collect data. The CEBQ is composed of 35 items and eight subscales.

Based on the analysis of parents’ reports, DD was higher in boys than girls, t (118) = 7.086, P < .001; EOE was higher in boys than girls, t (118) = 5.184, P < .001; EF was higher in boys than girls, t (118) = 2.183, P < .001; FF was higher in boys than girls, t (118) = 9.441, P < .001; and SR was higher in boys than girls, t (118) = 7.323, P < .001. However, EUE was lower in boys than girls, t (118) = −4.339, P < .001; FR was lower in boys than girls, t(118) = −3.112, P < .001; SE was lower in boys than girls, t(118) = −3.832, P < .001; thus, gender had a significant influence on eating habits of the school children.

Gender significantly affects the eating habits of Nigerian school children. Thus, gender is an important factor to be considered when aiming to improve the eating habits of Nigerian school children.
Evaluation of astragaloside IV in hepatic fibrosis
Authors: Han Zhongying , Zhu Junfeng , Han Zheng
Published: March 2021

To evaluate the effect of astragaloside IV for hepatic fibrosis.

The multiple databases like Pubmed, Embase, Cochrane databases, and China National Knowledge database were used to search for the relevant studies, and full-text articles involved in the evaluation on effect of astragaloside IV for hepatic fibrosis. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted.

Finally, 7 eligible studies were eventually satisfied the included criteria. Alanine aminotransferase (ALT) in model was higher than astragaloside group (mean difference [MD] = −58.01, 95% confidential interval (CI) [−93.97, −22.05],P = .002;I2 = 99%). The meta-analysis suggested that aspartate aminotransferase (AST) in model group was more than that in astragaloside group (MD = −39.94, 95% CI [−129.38, 49.50],P = .38;I2 = 100%). Model group had higher α - smooth muscle actin (α-SMA) than astragaloside group (MD was −1.13,Pof heterogeneity <.0001,I2 = 94%,Z = 5.18,Pof over effect <.0001). Transforming growth factor β (TGF-β) in model group was higher than that in astragaloside group (MD was −0.55,Pof heterogeneity <.00001,I2 = 97%,Z = 2.54,Pof over effect = .01). Limited publication bias was observed in this study.

Astragaloside IV is a potential clinical drug for the treatment of liver fibrosis considering liver function and hepatic fibrosis related protein factor in experimental rats are improved.
Preoperative evaluation and influencing factors of sentinel lymph node detection for early breast cancer with contrast-enhanced ultrasonography
Authors: Ma Shihui , Xu Yuguang , Ling Feihai
Published: March 2021

Sentinel lymph node (SLN) is important in the early diagnosis of breast cancer. We aimed to evaluate the role of contrast-enhanced ultrasonography (CEUS) in the preoperative evaluation for SLN and potentially influencing factors, to provide evidence to the management of breast cancer.

Patients with breast cancer who treated in our hospital from May 2018 to May 2020 were selected. All patients underwent CEUS examination to find SLN and judged whether the lymph node had cancer metastasis. We evaluated the sensitivity, specificity, and accuracy of CEUS in predicting SLN, and its differences in pathological diagnosis results and related influencing factors were also analyzed.

A total of 108 patients with breast cancer were included. And a total of 248 SLNs were detected. The sensitivity of CEUS to the preoperative evaluation of SLN was 84.67%, the specificity was 81.14%, the positive predictive value was 76.08%, and the negative predictive value was 89.27%, the positive likelihood ratio was 4.06, and the negative likelihood ratio was 0.14. The area under the curve of the preoperative evaluation of SLN in CEUS examination was 0.813 (95% confidence interval: 0.765–0.911), and there was significant difference in the size of SLNs between SLN-negative and SLN-positive groups (P = .043).

Preoperative CEUS has good predictive value for the SLN detection in patients with breast cancer, and it is worthy of clinical application.
Association of dipeptidyl peptidase IV polymorphism, serum lipid profile, and coronary artery stenosis in patients with coronary artery disease and type 2 diabetes
Authors: Wang Zhongsu , Liu Yang , Wang Weizong , Qu Haiyan , Han Yi , Hou Yinglong
Published: March 2021

Cardiovascular disease (CAD) is a devastating illness, but to date there are limited means of predicting a person's coronary stenosis severity and their prognosis. The study was performed to investigate the relationship between dipeptidyl peptidase 4(DPP4) gene polymorphisms and serum lipid profiles, as well as the severity of coronary artery stenosis in patients with CAD and type 2 diabetes (T2DM) for the first time.

Herein, 201 patients with CAD and T2DM were enrolled in the Department of Cardiology, Shandong Provincial Qianfoshan Hospital. DPP4 rs3788979 and rs7608798 single nucleotide polymorphisms (SNPs) were genotyped. The general information of all patients was collected, and the associations between DPP4 SNPs and lipid profiles were detected. At the same time, association between SNP polymorphisms and the degree of coronary artery stenosis were analyzed.

There was a significant difference in apolipoprotein B (ApoB) levels (P = .011) for the rs3788979 polymorphism, while no difference was identified in other blood lipids or with other mutations. SNP mutation of A to G in rs3788979 was associated with a reduced percentage of severe coronary artery stenosis in female patients (P = .023) as well as those with nosmoking (P = .030), nodrinking (P = 0.007), and nocardiovascular family history (P = 0.015).

G allele of rs3788979 is associated with a reduced ApoB level. Besides, we suggest that G allele in rs3788979 may have a cardioprotective effect and prove to be a useful and specific measure when predicting a patient's coronary stenosis severity if diagnosed with CAD and T2DM.
Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture
Authors: Li Kaiming , Gong Hao , Xie Rui , Gu Jinyu , Wang Shangquan , Lin Chengyu , Yin Jing , Hou Xiaozhou , Zhang Qing , Li Linghui , Hao Yanke
Published: March 2021

Objective:

The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients.

Methods:

The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators.

Results:

In this study,

The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up (P < .05). After PKP operation, ZOL injections reduced the rate of RVF (P < .05). In the comparison of ODI scores, the experimental group improved compared with the control group (P < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group (P < .05).

Conclusion:

Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.
Long-term oncological outcome in patients with cervical cancer after 3 trimodality treatment (radiotherapy, platinum-based chemotherapy, and robotic surgery)
Authors: Trifanescu Oana Gabriela , Gales Laurentia Nicoleta , Serbanescu Georgia Luiza , Zgura Anca Florina , Iliescu Laura , Mehedintu Claudia , Anghel Rodica Maricela
Published: March 2021

Cervical cancer represents a general health issue spread all over the globe, which prompts the surge of scientific survey toward the rise of survival and condition of life of these patients. American and European guidelines suggest the open surgery, laparoscopic, and robotic surgery are the main therapeutic approaches for radical hysterectomy for patients with cervical cancer. This is the first survey to analyze the long-term oncological outcome of an extensive series of subjects cared for with multimodality treatment, here comprising robotic surgery.

This study intents to evaluate the long-term oncological result in patients diagnosed with cervical cancer treated with radiotherapy (±chemotherapy) and robotic surgery compared with open surgery. Medical files of 56 patients diagnosed with cervical cancer who underwent a robotic hysterectomy and radiotherapy ± chemotherapy were retrospectively analyzed.

The median age at diagnosis was 50.5 (range: 23–70). Eleven patients (19.6%) presented in an early stage (IB–IIA) and 80.4% advanced stage (IIB–IVA). Overall response rate after radiotherapy and chemoradiotherapy was 96.2%. Pathologic complete response was obtained in 64% of patients. After a median follow-up of 60 months (range: 6–105 months), 8 patients (14.2%) presented local recurrence or distant metastases. Disease-free survival (DFS) was 92% at 2 years and 84% at 3 and 5 years. Overall survival (OS) rates at 2, 3, and 5 years for patients with robotic surgery were 91%, 78%, and 73%, median OS not reached. OS was lower in the arm of open surgery (2, 3, and 5 years 87%, 71%, and 61%, respectively; median OS was 72 months P = .054). The multivariate analysis regarding the outcome of patients revealed an advantage for complete versus partial response (P < .002), for early versus advanced stages (P = .014) and a 10% gained in DFS at 3 years for patients in whom chemoradiotherapy was administered (DFS at 3 years 75% vs 85%) in patients with advanced stages.

Robotic surgery has a favorable oncological outcome when associated with multimodal therapy.
Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program
Authors: Patti Antonino , Zangla Daniele , Sahin Fatma Nese , Cataldi Stefania , Lavanco Gioacchino , Palma Antonio , Fischietti Francesco
Published: March 2021

Introduction:

Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling.

Materials and Methods:

Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis.

Results:

Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = −0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G.

Discussion and conclusions:

This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.
Fire needle therapy for blood stasis syndrome of plaque psoriasis
Authors: Huang Gang , Yan Juan , Zou Jiahua , Hu Chuxiang , Huang Dongbei , Huang Qiang , Chen Peize , Zhang Feiyan , Gong Liping
Published: March 2021

Background:

Plaque psoriasis (PSO) is a common clinical chronic inflammatory skin disease. The incidence rate is increasing year by year due to the fast pace of work and unhealthy diet. Fire needle has been widely used in the treatment of PSO. However, the efficacy of fire needle for PSO is uncertain. Thus, the purpose of this systematic review is to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome).

Methods:

The following electronic databases will be searched from inception to October 2020:PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. In addition, other documents that meet the requirements will be manually searched, including conference papers, dissertations, etc. All randomized controlled trials using fire needle to treat PSO (blood stasis syndrome) that meet the criteria for inclusion will be included. The primary outcomes are clinical efficacy, Psoriasis area and severity index. Secondary outcomes include Itchy, TCM evaluation standard syndrome score, Dermatological quality of life index, and adverse events. To complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software.

Results:

The review results will be published in a peer-reviewed journal.

Conclusion:

This study will provide high-quality evidence based medicine to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome), and further seek its scientific and effective chinese medicine treatment methods.

INPLASY registration number:

INPLASY202120007.
Is preemptive analgesia a good choice for postoperative pain relief in lumbar spine surgeries?
Authors: Zhang Lu-kai , Li Qiang , Quan Ren-Fu , Liu Jun-Sheng
Published: March 2021

Background:

Lumbar spine surgery is associated with moderate-to-severe postoperative pain. Adequate pain management during the postoperative period facilitates rehabilitation. Recently, preemptive analgesia has been considered among the important analgesic methods for reducing postoperative pain. However, its efficacy in postoperative pain relief after lumbar spine surgery remains unclear. This study aimed to evaluate the effects of preemptive analgesia on lumbar spine surgery.

Methods:

We searched for randomized controlled trials in PubMed (1996 to May 2020), Embase (1980 to May 2020), and Cochrane Library (CENTRAL, May 2020). We included seven studies that evaluated the preemptive analgesic efficacy in lumbar spine surgeries.

Results:

Seven studies, including 509 patients, met the inclusion criteria. Pooled data revealed that preemptive analgesia is effective for lumbar spine surgeries with respect to the visual analog scale score (P < .05), total morphine equivalent consumption (P < .05), and length of stay (P < .05), without increasing complications (P = .73).

Conclusions:

Our findings indicate that preemptive analgesia is safe and effective for lumbar spine surgery.
Different Chinese herbal medicine therapy for idiopathic thrombocytopenic purpura
Authors: Chen Wen-Ting , Tang Rui-Mei , Huang Ying , Pan Yan-Ping , Wang Shu-Wen , Wang Gu-Yun
Published: March 2021

Background:

Idiopathic thrombocytopenic purpura (ITP) is a common immune system and blood system disease in clinical practice, and it is a hemorrhagic disease caused by immune factors causing platelet destruction and decreasing number of platelets. There is currently no effective treatment plan for ITP. At this stage, glucocorticoid and gamma globulin are mostly used in the treatment of ITP, and some patients use splenectomy to achieve therapeutic purposes, but the various treatment methods are inadequate. At this stage, a large number of randomized controlled studies have reported that Chinese herbal medicine has achieved good curative effect in the treatment of ITP. However, due to the variety of Chinese herbal medicine, there has been no evidence of the effectiveness and safety of Chinese herbal medicine in the treatment of ITP. Because of the above reasons, this study uses the network meta-analysis method based on Bayesian method to compare the clinical efficacy and safety of different kinds of Chinese herbal medicine in the treatment of ITP through direct and indirect comparison, in order to provide evidence-based medical support for the treatment of ITP with Chinese herbal medicine.

Methods:

This study uses the method of combining free words with theme words, and using computer to retrieve PubMed, EMbase, The Cochrane Library, WANFANG Database, CNKI, and VIP Database, etc, to collect the randomized control studies on Chinese herbal medicine in the treatment of ITP. The retrieval time is from the establishment of each database to January 2021, and the retrieval languages are Chinese and English. Two researchers independently read the title, abstract and full text of the article to determine whether it is included in the literature; In the event of a disagreement, a third researcher will join the discussion to resolve the disagreement; For the literature that lacks information, trying to contact the original author of the document to supplement it. The literature quality evaluation carried out by using the Stata 14.0 software to draw network and funnel plots, in accordance with the quality evaluation criteria of version 5.1.0 of the Cochrane System Evaluation Manual. Statistical analysis is performed by using ADDIS 1.16.8 software based on the Bayesian model.

Results:

This study will compare the clinical efficacy and safety of different types of Chinese herbal medicine in the treatment of idiopathic thrombocytopenic purpura through the method of network meta-analysis, and rank the different types of Chinese herbal medicine according to their effectiveness, and the results will be published in a peer-reviewed, high-quality academic journal.

Conclusion:

This study will find effective and safe Chinese herbal medicine for clinical treatment of ITP from the perspective of evidence-based medicine, and benefit more ITP patients.
Clinical experience with biologic treatment in resistant eosinophilic fasciitis
Authors: Erez Daniel , Shoenfeld Yehuda , Natour Ayman , Dovrish Zamir , Tayer-Shifman Oshrat E. , Levy Yair
Published: March 2021

Rationale:

Eosinophilic fasciitis (EF) is an uncommon connective tissue disorder characterized by limb and trunk erythema, with symmetrical thickening of the skin. Its pathogenesis is poorly understood. Treatment consists mainly of glucocorticoids. Yet, no randomized trials have evaluated therapies for this rare disease and the optimal treatment modality remains unclear. Although most patients show partial or complete response to glucocorticoids, many relapse upon drug tapering, while others either do not respond at all or fail to sustain prolonged remission. Second-line therapy for this rare disorder includes mainly methotrexate (MTX), azathioprine, cyclosporine and hydroxychloroquine. Recently, several attempts using rituximab and intravenous immunoglobulins (IVIG) have shown good clinical results.

Patient concerns:

The three patients had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. Adding methotrexate in all patients and azathioprine to patient 3 did not lead to remission.

Diagnoses:

EF was diagnosed in all patients based on clinical presentation accompanied by fascia biopsy that demonstrated eosinophilic fasciitis.

Interventions:

The patients were successfully treated with rituximab or IVIG, achieving sustained remission.

Outcomes:

The three cases had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. The patients were then successfully treated with rituximab or IVIG, achieving sustained remission.

Lessons:

This review of three cases of EF supports the results of previous reports, suggesting addition of rituximab and IVIG is an effective treatment for patients with refractory disease.
The Development and Implementation of Preventive Medicine Resident Rotations in a Shelter Serving Asylum-Seekers at the US-Mexico Border
Authors: Hill Linda , Fischer Kathleen , Thorne Christine , Horton Lucy E. , Folsom Emilie
Published: March 2021

Asylum-seekers present to the US-Mexico border with a variety of acute health needs. In December 2018, the County of San Diego Health and Human Services Agency partnered with the University of California, San Diego to provide health screenings to asylum-seekers at a humanitarian shelter administered by Jewish Family Services. The assessments screened for communicable diseases and acute conditions. Preventive medicine residents in the HRSA-funded UCSD-SDSU (University of California, San Diego–San Diego State University) Residency were trained to become an integral part of the program. Training included cultural competency, public health interface, protocol development and implementation, interdisciplinary teamwork, and quality improvement. Over 18 months, nearly 20000 asylum-seekers were screened, which allowed for the detection of an imported influenza outbreak and prevented any major public health incidents or medical errors. This health screening program for asylum-seekers provided an important experience for preventive medicine trainees. In turn, preventive medicine and other trainees were valuable contributors to the program.
Preventive Medicine for Rural America: Why More Training Programs Must Be Here
Authors: Lultschik Jennifer L. , Martin Christopher J.
Published: March 2021

While there is a well-recognized national shortage of Preventive Medicine (PM) physicians, there is also a marked maldistribution. Since 47.5% of physicians were active in the state where they completed their most Graduate Medical Education (GME), one approach to address the disparity in PM specialists in practice within rural regions such as Appalachia is by supporting a greater number of GME programs based within these regions. Currently, of the 64 accredited civilian PM residency programs, only 4 are located in rural areas. The only PM residency programs based in the entire Appalachian region are based at West Virginia University. Several threats to the establishment and sustainability of rural-based PM GME programs have been identified, including challenges in securing support through competitive national grants, the limited number of board-certified community preceptors, and difficulty in recruiting and retaining both core program faculty and trainees. Targeted efforts to promote and support GME programs that are based in rural areas of need, such as the Health Resources and Services Administration's Rural Residency Planning and Development Program, will help address this disparity.
Association Between Self-Reported Dyspnea and Depressive Symptoms in New Mexico Uranium Workers
Authors: Sharma Shiva , Crisanti Annette , Kesler Denece , Shore Xin W. , Vlahovich Kevin , Sood Akshay
Published: March 2021

New Mexico has the largest number of former uranium workers, mostly racial/ethnic minorities. Uranium workers are at risk for dyspnea secondary to mine dust exposure. The association between dyspnea and depressive symptoms has not been well examined in occupational minority cohorts. This study evaluated the associations between dyspnea (measured by the modified Medical Research Council Questionnaire) and depressive symptoms (measured by the Patient Health Questionnaire-2) in former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program. The subjects were mostly elderly, rural-residing, minority males. Dyspnea was commonly reported; however, depressive symptoms were uncommon. At baseline, former workers experiencing higher levels of dyspnea were more than 3 times likely to endorse depressive symptoms than those with no or mild dyspnea. Longitudinal analysis failed to determine an association between change in dyspnea and concomitant change in depressive symptoms. Dyspnea and depressive symptoms were associated cross-sectionally in former uranium workers.
Preventive Medicine Physicians' Role in Health Care Organizations' Pursuit of the Triple Aim
Authors: Jamison Shaundreal D. , Higginbotham Laura B. , Chambard Megan L. , White Dolly P. , Porterfield Deborah S. , Flower Kori B.
Published: March 2021

Context:

The Institute for Healthcare Improvement's Triple Aim is rooted in improving population health and therefore requires a focus on prevention as well as management of disease. Preventive medicine (PM) physicians are uniquely trained in clinical medicine as well as health care delivery and systems-based practice, thus potentially positioning them to lead population health and contribute to the Triple Aim.

Objective:

The objectives of this study were to (1) describe PM physicians' contributions related to the Triple Aim and (2) describe PM physician satisfaction with these activities.

Design:

A survey was administered to physicians graduating from a single Preventive Medicine Residency program between 1975 and 2015. Physicians were asked about work in 3 specific emerging areas that relate to the Triple Aim's focus on population health improvement: population health; health system transformation; and integration between primary care and public health. PM physicians were also asked about their job, career, and specialty satisfaction.

Results:

Most respondents (74%) practiced population health, with the majority (63%) defining this as improving the health of the population at large versus for a defined clinical population (37%). Approximately half (59%) of PM physicians are involved in health system transformation leadership. Most respondents practice both public health and primary care, but only 32% report having had positions that involve integration of these activities. PM physicians reported high specialty satisfaction levels, particularly among those involved in population health and health care transformation.

Conclusion:

PM physicians already make substantial contributions to population health and lead work related to the Triple Aim. High satisfaction among PM physicians suggests that they can contribute to a stable and sustainable population health workforce.
Adaptation of the Flu-FIT Program for Patient-Aligned Care Teams: A Quality Improvement Project
Authors: Funes Sofia A. , Flores Claudia , Davidow Amy L. , Friedman Stephen , Korenblit Pearl , Thomas Pauline
Published: March 2021

The Flu-FIT program aims to increase colorectal cancer screening rates by offering a home fecal immunochemical test (FIT) at the time of annual influenza immunization. This program was piloted at a VA campus in New Jersey during the 2018-2019 influenza season, with a 9% increase in colorectal cancer screening rates. In the 2019-2020 season, the program was implemented in 6 primary care teams; 6 additional teams maintaining standard of care served as a comparison group. A total of 816 patients aged 50 to 75 years were eligible for participation; 509 patients were available for analysis, 242 in the Flu-FIT group and 267 in the comparison group. The Flu-FIT group patients were 2.4 times more likely to accept FIT kits (95% confidence interval: 1.6-3.6, P = .001). The colorectal cancer screening rates increased 77.0% to 81.9% in the Flu-FIT group and 77.0% to 79.8% in the comparison group (P > .05).
Outcomes of a Survey-Based Approach to Determine Factors Contributing to the Shortage of Occupational Medicine Physicians in the United States
Authors: Green-McKenzie Judith , Savanoor Uma , Duran Harry , Jones Crystal , Vearrier David , Malak Paul , Emmett Edward A. , Shofer Frances S.
Published: March 2021

Context:

There is a long-standing shortage of formally trained Occupational & Environmental Medicine (OEM) physicians despite OEM practitioners experiencing high satisfaction and low burnout.

Objective:

To explore the root causes of this shortage and suggest potential remedies.

Methods:

Cross-sectional surveys were administered to medical students queried regarding OEM training, practicing OEM physicians queried regarding timing of specialty choice, and OEM Train-in-Place (TIP) program graduates queried regarding satisfaction with training.

Results:

Of 247 medical student respondents, 70% had heard of OEM, 60% through one lecture. Of the 160 OEM physicians, 17% first became aware of OEM as medical students, and most would have chosen a different path had they heard sooner. Most TIP program trainees reported that they would not have undertaken specialty training without a TIP program (89%).

Conclusions:

Strategies to introduce OEM earlier in medical education and TIP programs for mid-career physicians may help overcome persistent shortages of OEM specialists.
Assessing Community Needs to Combat the Opioid Epidemic in Washtenaw County, Michigan
Authors: Marquez Juan Luis , Loveluck Jimena , Marshall Jessie Kimbrough , Power Laura
Published: March 2021

A needs assessment was performed to inform the strategic plan of the Washtenaw Health Initiative Opioid Project (WHI-OP). A Health Resources & Services Administration–funded preventive medicine resident supported this work by conducting and analyzing surveys and face-to-face interviews. Surveys were distributed to community organizations involved in opioid prevention and treatment and medical providers in the major health care systems. Individual interviews were conducted with key stakeholders. Overall, the top 5 needs identified were (1) pain management treatment options, (2) addressing provider stigma, (3) community education of opioids and substance abuse, (4) access to substance use disorder treatment, and (5) better guidelines to manage care for patients with substance use disorder, given the evolving Michigan prescription laws. The findings served as a foundation for a new strategic plan for the WHI-OP. The needs assessment was accomplished through the work of the preventive medicine resident in close collaboration with the WHI-OP and the Washtenaw County Health Department.