bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavior Change Techniques in Continuing Professional Development
Authors: Konnyu Kristin J. , McCleary Nicola , Presseau Justin , Ivers Noah M. , Grimshaw Jeremy M.
Published: December 2020

Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. While synthesized evidence shows CPD in general to be effective, effects vary, in part due to variation in CPD interventions and limited understanding of CPD mechanisms of action. We introduce two behavioral science tools—the Behavior Change Technique Taxonomy version 1 and the Theoretical Domains Framework—that can be used to characterize the content of CPD interventions and the determinants of behaviour potentially targeted by the interventions, respectively. We provide a worked example of the use of these tools in coding the educational content of 43 diabetes quality improvement trials containing clinician education as part of their multicomponent intervention. Fourteen (of a possible 93; 15%) behavior change techniques were identified in the clinician education content of the quality improvement trials, suggesting a focus of addressing the behavioral determinants beliefs about consequences, knowledge, skills, and social influences, of diabetes care providers' behavior. We believe that the Behavior Change Technique Taxonomy version 1 and Theoretical Domains Framework offer a novel lens to analyze the CPD content of existing evidence and inform the design and evaluation of future CPD interventions.
Targeted inhibition of myeloid-derived suppressor cells in the tumor microenvironment by low-dose doxorubicin to improve immune efficacy in murine neuroblastoma
Authors: Xu Wei-Li , Shi Bao-Jun , Li Suo-Lin , Yu Feng-Xue , Guo Li-Na , Li Meng , Hu Zhi-Gang , Li Gui-Xin , Zhou Hui
Published: December 2020

Background

High agglomeration of myeloid-derived suppressor cells (MDSCs) in neuroblastoma (NB) impeded therapeutic effects. This study aimed to investigate the role and mechanism of targeted inhibition of MDSCs by low-dose doxorubicin (DOX) to enhance immune efficacy in NB.

Methods

Bagg albino (BALB/c) mice were used as tumor-bearing mouse models by injecting Neuro-2a cells, and MDSCs were eliminated by DOX or dopamine (DA) administration. Tumor-bearing mice were randomly divided into 2.5 mg/kg DOX, 5.0 mg/kg DOX, 50.0 mg/kg DA, and control groups (n = 20). The optimal drug and its concentration for MDSC inhibition were selected according to tumor inhibition. NB antigen-specific cytotoxic T cells (CTLs) were prepared. Tumor-bearing mice were randomly divided into DOX, CTL, anti-ganglioside (GD2), DOX+CTL, DOX+anti-GD2, and control groups. Following low-dose DOX administration, immunotherapy was applied. The levels of human leukocyte antigen (HLA)-I, CD8, interleukin (IL)-2 and interferon (IFN)-γ in peripheral blood, CTLs, T-helper 1 (Thl)/Th2 cytokines, perforin, granzyme and tumor growth were compared among the groups. The Wilcoxon two-sample test and repeated-measures analysis of variance were used to analyze results.

Results

The slowest tumor growth (F = 6.095, P = 0.018) and strongest MDSC inhibition (F = 14.632, P = 0.001) were observed in 2.5 mg/kg DOX group. Proliferation of T cells was increased (F = 448.721, P < 0.001) and then decreased (F = 2.047, P = 0.186). After low-dose DOX administration, HLA-I (F = 222.489), CD8 (F = 271.686), Thl/Th2 cytokines, CD4+ and CD8+ lymphocytes, granzyme (F = 2376.475) and perforin (F = 488.531) in tumor, IL-2 (F = 62.951) and IFN-γ (F = 240.709) in peripheral blood of each immunotherapy group were all higher compared with the control group (all of P values < 0.05). The most significant increases in the aforementioned indexes and the most notable tumor growth inhibition were observed in DOX+anti-GD2 and DOX+CTL groups.

Conclusions

Low-dose DOX can be used as a potent immunomodulatory agent that selectively impairs MDSC-induced immunosuppression, thereby fostering immune efficacy in NB.
Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: a Chinese cohort study
Authors: Zeng Yong-Qin , Xiao Jiang , Li Cui-Lin , Wang Yu , Zhang Ling , Pang Xiao-Li , Wang Di , Du Juan , Zhao Hong-Xin
Published: December 2020

Background

Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China.

Methods

The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression.

Results

Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m2) was positively associated with reduced BMD (Exp (B) = 39.743, 95% confidence interval: 3.234–488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine).

Conclusion

Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.
When Healthcare Isn't Enough
Authors: Lathrop Breanna
Published: December 2020

Education, employment, housing, neighborhood safety, and traumatic life experiences influence people's health, and poor health as a result of inequities in these areas cannot be remedied by medical care alone. Although social determinants of health threaten the attainment of a healthy life for people across North America, nurses are positioned to be leaders in a movement toward health equity. Nurses can follow the example of Jesus in loving their neighbors as themselves by addressing the social needs of patients, championing health system change, educating their communities, and advocating for Health in All Policies.
Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception
Authors: Coeckelenbergh Sean , Doria Stefano , Patricio Daniel , Perrin Laurent , Engelman Edgard , Rodriguez Alexandra , Di Marco Livia , Van Obbergh Luc , Estebe Jean-Pierre , Barvais Luc , Kapessidou Panayota
Published: December 2020

BACKGROUND

The effect of dexmedetomidine on Nociception Level Index-guided (Medasense, Israel) antinociception to reduce intra-operative opioid requirements has not been previously investigated.

OBJECTIVE

We aimed to determine if low-dose dexmedetomidine would reduce remifentanil requirements during Nociception Level Index-guided antinociception without increasing complications associated with dexmedetomidine.

DESIGN

Double-blind randomised controlled trial.

SETTING

Two university teaching hospitals in Brussels, Belgium.

PATIENTS

American Society of Anesthesiologists 1 and 2 patients (n = 58) undergoing maxillofacial or cervicofacial surgery under propofol--remifentanil target-controlled infusion anaesthesia.

INTERVENTIONS

A 30 min infusion of dexmedetomidine, or equal volume of 0.9% NaCl, was infused at 1.2 μg kg−1 h−1 immediately preceding induction and then decreased to 0.6 μg kg−1 h−1 until 30 min before ending surgery. Nociception Level Index and frontal electroencephalogram guided the remifentanil and propofol infusions, respectively.

MAIN OUTCOMES

The primary outcome was the remifentanil requirement. Other outcomes included the propofol requirement, cardiovascular status and postoperative outcome.

RESULTS

Mean ± SD remifentanil (3.96 ± 1.95 vs. 4.42 ± 2.04 ng ml−1; P = 0.0024) and propofol (2.78 ± 1.36 vs. 3.06 ± 1.29 μg ml−1; P = 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 ± 0.085 vs. 0.198 ± 0.086 μg kg−1 min−1; P = 0.0074) and propofol (5.7 ± 2.72 vs. 7.4 ± 2.80 mg kg−1 h−1; P = 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision.

CONCLUSION

In ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia.

TRIAL REGISTRATIONS

Clinicaltrials.gov: NCT03912740, EudraCT: 2018-004512-22.
Effect of Secondary Prevention Medication on the Prognosis in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease
Authors: Abdu Fuad A. , Liu Lu , Mohammed Abdul-Quddus , Xu Bin , Yin Guoqing , Xu Siling , Xu Yawei , Che Wenliang
Published: December 2020

Myocardial infarction with nonobstructive coronary arteries (MINOCA) has been and remained a puzzling clinical entity. The role of secondary prevention therapy in patients with MINOCA remains unclear. This study aimed to evaluate the associations between secondary prevention medications and outcomes in patients with MINOCA. A total of 259 patients with MINOCA were consecutively enrolled. Basic information and medication of patients were assessed. We defined major adverse cardiovascular events as the primary end point and angina rehospitalization as the secondary end point. Logistic regression models were used to assess the correlation between treatment and outcomes. The proportion of statins, aspirin, clopidogrel, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), and β-blocker used at admission was 88.8%, 86.9%, 84.6%, 51.7%, and 61.4%, respectively. At discharge, patients with MINOCA were less likely to be released on statins, aspirin, clopidogrel, ACEI/ARB, and β-blocker. The use of secondary prevention medications was significantly lower at 2 years of follow-up with the most significant reductions being clopidogrel 29.4%, ACEI/ARB 39.0%, and aspirin 42.3%. About 19.1% of patients with MINOCA suffered adverse events during the follow-up period. Adverse events risk decreased when statins and ACEI/ARB were used, whereas the risk of adverse events was not lower in patients with aspirin, clopidogrel, and β-blocker. In conclusion, patients with MINOCA were less likely to receive secondary prevention medications at the time of discharge and early discontinuation of medications at the time of follow-up. Statins and ACEI/ARB were the only medications substantially associated with lower adverse events; by comparison, aspirin, clopidogrel, and β-blocker seem to have no impact on prognosis.
Characterization of Endothelial Cell Loss in Pre-Descemet Endothelial Keratoplasty Graft Preparation
Authors: Bedard Peter , Hou Joshua H.
Published: December 2020

Purpose:

To characterize the pattern and factors affecting endothelial cell loss (ECL) in pre-Descemet Endothelial Keratoplasty (PDEK) graft preparation.

Methods:

A prospective study was performed to characterize the pattern of ECL and the impact of inflation pressure in PDEK. Donor corneas were randomized to inflation with air versus Optisol GS storage media. PDEK preparation was performed under continuous pressure monitoring. Trypan blue was used to grade the tissue as acceptable (<25% ECL) or unacceptable (≥25% ECL). Rate of unacceptable ECL was correlated with injection media type and inflation pressure. A retrospective study was then performed of all attempted PDEK preparations at Lions Gift of Sight to evaluate impact of donor tissue factors on ECL. Donor age and tissue preservation time were evaluated and correlated with ECL with PDEK bubbling.

Results:

Twenty-five corneas were tested prospectively. A reticular pattern of ECL that varied in severity occurred with bubbling. There was no difference in peak inflation pressure or mean expansion pressure between air (706.0, 510.7 mm Hg) and Optisol GS (852.9, 653.0 mm Hg). Increasing peak inflation pressure and mean expansion pressure were associated with an increased risk for unacceptable ECL. On retrospective evaluation of 131 attempted PDEKs, only 44.0% of cases with successful bubbles had acceptable endothelium after processing. Increasing donor age and decreasing preservation time were associated with increased rates of acceptable endothelium.

Conclusions:

PDEK processing can result in a reticular pattern of ECL. Higher inflation pressures are associated with greater ECL. Older donor tissues with shorter preservation times might be preferable for PDEK.
Systematic Review of Postcochlear Implant Electrode Migration: What Is Known?
Authors: Alenzi Saad , Khurayzi Tawfiq , Alshalan Afrah , Almuhawas Fida , Alsanosi Abdulrahman
Published: December 2020

Background and Objectives:

Electrode migration after cochlear implantation (CI) is a rare complication that accounts for 1to 15% of all revision surgery. This study is a systematic review of the literature for investigating the knowledge and approaches to the incidence of electrode migration after CI.

Methods:

A systematic electronic search of the literature was carried out using PubMed, Cochrane, Virtual Health Library, Scopus and Web of Science (ISI). All original articles that reported electrode migration after CI surgery were included. The Newcastle-Ottawa Scale and CARE checklist were utilized for the assessment of the risk of bias. Descriptive data analysis was performed using SPSS software.

Results:

A total of 26 studies including 4,316 patients were included. Out of them, 289 patients had electrode migration following CI. To diagnose electrode migration, traditional computed tomography scan was used in 13 studies, while cone-beam computed tomography was applied in three studies. In addition, electrode migration was detected during intraoperative exploration in eight studies. The most common presenting symptom was change in sound/poor performance (n = 43) followed by pain sensation (n = 15) and facial nerve stimulation (n = 10). Cholesteatoma was the most common associated pathology (n = 10) followed by infection (n = 9) and ossification of the basal turn of the cochlea (n = 8).

Conclusion:

Electrode migration is a major complication of CI and could be more common than previously thought. As it may occur with or without clinical complaints, long-term follow-up through routine radiological scanning is recommended. Further studies are warranted to identify the underlying mechanism of electrode extrusion and the appropriate fixation method.
Prognostic Factors for Communication Improvement in Young Children After Cochlear Implant Surgery
Authors: Yang Fang-Jane , Yeh Li-Li , Wu Che-Ming
Published: December 2020

Objective:

Our objective was to examine the prognostic factors for post-cochlear implant (CI) communication improvement and determine whether the otologist's and speech-language pathologist's (SLP's) recommendations exhibited the same predictive performance regarding children's post-CI verbal expression acquisition.

Study Design:

Retrospective, diagnostic study.

Setting:

Hospital.

Patients:

The study reviewed 339 medical charts of preschool children who underwent CI surgery before the age of 6 years during 1999 to 2016. After these medical charts were assessed, the cohort comprised of 79 preschool children with pre- and post-CI surgery speech-language assessment reports and medical records.

Intervention:

A senior SLP and an otologist conducted blind testing of CI candidacy according to the 79 children's pre-CI reports.

Main Outcome Measures:

Spoken mean length of utterance (MLU).

Results:

Children with superior skills in comprehending facial and gesture expressions or using gestures or sounds for expression were significantly more likely to receive the SLP's recommendation for CI surgery. The SLP's CI candidacy recommendation, based on background information, communication skill assessments, and magnetic resonance imaging (provided by an otologist), had significant predictive effects. Children recommended by the SLP exhibited a 20 times higher probability of benefiting from CI surgery; such a benefit would be a longer MLU after 2 years.

Conclusion:

CI candidacy testing for young children with prelingual hearing impairment based on a SLP's recommendations provided significant predictive effects.

Level of Evidence:

4 (Evidence from well-designed case–control or cohort studies).
The effectiveness of acupuncture and moxibustion for treating tenosynovitis
Authors: Huang Shouqiang , Fan Qian , Xiong Jun , Liao Kai , Hua Fanghui , Xiang Jie , Li Changsheng , Jin Hangyu
Published: December 2020

Background:

De Quervain's tenosynovitis is an overuse disease that involves a thickening of the abductor pollicis longus and extensor pollicis brevis tendons. Evidence shows that acupuncture and moxibustion (AM) could remarkably relieve the pain of De Quervain's tenosynovitis patients. The aim of this protocol is to determine the efficacy and safety of AM for treating De Quervain's tenosynovitis.

Methods:

Several online databases including PubMed, Cochrane Library, Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, WangFang Database, Chinese Scientific Journal Database will be searched from their establishment to July 1, 2020. We will include all randomized controlled trials using AM as the method for treating De Quervain's tenosynovitis, regardless of blinding or publication types. The selection of studies, data extraction and the assessment of the studies quality will be conducted by 2 reviewers separately. When there is sufficient available data for meta-analysis, we will use the RevMan V.5.3 statistical software for data synthesis. The total effective rate, range of motion of wrist ulnar deviation will be the primary outcomes, and the secondary outcomes contain Visual Analog Scale, Coney Wrist Score and side effects. We will express the result by using Risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data.

Results:

The results of this study be presented in corresponding journal or conferences.

Conclusions:

This study is designed to provide sufficient evidence to assess the exact effectiveness of AM on De Quervain's tenosynovitis.

PROSPERO registration number:

CRD42020158764.
Complete monoplegia due to limb-kinetic apraxia in a patient with traumatic brain injury
Authors: Jang Sung Ho , Seo You Sung
Published: December 2020

Rationale:

Limb-kinetic apraxia (LKA) is a disorder of movement execution that is a result of injury to the corticofugal tracts (CFTs) from the secondary motor area. We report on a patient with traumatic brain injury (TBI) and complete monoplegia due to LKA, which was mainly ascribed to injury of the CFT from the secondary motor area using diffusion tensor tractography.

Patient concerns:

A 35-year-old male was struck by a car from the side during riding an autocycle and received direct head trauma as a result of falling to ground. He lost consciousness for approximately 1 month and experienced continuous post-traumatic amnesia after the accident. The patient's Glasgow Coma Scale score was 3 and he showed quadriparesis including complete monoplegia of his left arm since the onset of TBI.

Diagnoses:

The patient diagnosed complete monoplegia due to LKA after traumatic brain injury.

Interventions:

He underwent conservative management for TBI followed by rehabilitation at approximately 2 months after onset. Outcomes: At 32-month after onset, weakness on left arm (Manual Muscle Test [MMT]:0) and partial weakness of left leg (MMT:3).

Outcomes:

Results of electromyography and nerve conduction studies of left extremities were normal. Motor evoked potential values obtained from the abductor pollicis brevis muscle (APB) were: right APB latency 22.3msec, amplitude 1.6mV; left APB latency 22.8msec, amplitude 1.5mV. After 2 weeks of administration of dopaminergic drugs for improvement of LKA, left arm weakness had recovered to level that permitted movement against gravity (MMT:3). Diffusion tensor tractography at 32-month after onset showed right corticospinal tract discontinuation at the pontine level and partial tearing of the left corticospinal tract at the subcortical white matter. In addition, the left CFT from the supplementary motor area showed partial tearing at the subcortical white matter.

Lessons:

The LKA due to injury of the left supplementary motor area-CFT was demonstrated in a patient with complete monoplegia following TBI. Accurate diagnosis of LKA is important for successful rehabilitation because LKA is known to respond to dopaminergic drug treatment.
Efficacy and safety of thread embedding acupuncture combined with acupuncture for chronic low back pain
Authors: Sung Won-Suk , Hong Yejin , Jeon Sae-Rom , Yoon Jimin , Chung Eun Kyoung , Jo Hyeong Geun , Kim Tae-Hun , Shin Seungwon , Lee Hyun-Jong , Kim Eun-Jung , Seo Byung-Kwan , Choi Jieun , Nam Dongwoo
Published: December 2020

Background:

Low back pain is a very common disease. Many patients with chronic low back pain (CLBP) have been treated by complementary and alternative medicine such as acupuncture (AT) treatment. A type of AT, thread embedding acupuncture (TEA), consists of a thread that can continually stimulate at the AT points and has mechanical and chemical effects. Although TEA was widely used in clinical practice, there was little evidence of its efficacy and safety for CLBP.

Methods:

This clinical trial was randomized, controlled, assessor-blinded, two-armed, parallel, and conducted in multiple centers. Four Korean medical institutions recruited 38 outpatients with CLBP. The participants were randomly allocated to a treatment group (TEA combined with AT) or a control group (only AT) in a 1:1 ratio. All participants received conventional AT twice a week for 8 weeks (16 sessions) at 15 AT points (GV3 and bilateral BL23, BL24, BL25, BL26, BL40, BL60, and EX-B5) and the treatment group participants additionally received TEA once a week for 8 weeks (8 sessions) on 10 AT points in the multifidus, spinal erector, and lumbar quadrate muscles. The primary outcome measure of this study was the change of visual analog scale (VAS) from baseline (0 week) to the end of intervention (8 weeks). Secondary outcome measures included clinically relevant improvement (minimal clinically important difference) and 3% to 50% decrease on VAS, disability level (Korean version of Roland and Morris disability questionnaire), quality of life (Korean version of European quality of life 5dimension), global assessment (patient global impression of change), economic analysis, credibility test, and safety assessment.

Results:

The treatment group showed a significant reduction in VAS scores when compared with the control group (–33.7 ± 25.1 vs –15.6 ± 17.0, P = .013). As for the secondary outcome measures, the treatment group showed significant difference in 50% decrease on VAS and patient global impression of change. There was no serious adverse event associated with TEA and AT.

Conclusion:

This clinical trial documents the efficacy and safety of TEA combined with AT for the management of CLBP.
Mining of gene modules and identification of key genes in head and neck squamous cell carcinoma based on gene co-expression network analysis
Authors: Zhao Qian , Zhang Yan , Zhang Xue , Sun Yeqing , Lin Zhengkui
Published: December 2020

To explore the gene modules and key genes of head and neck squamous cell carcinoma (HNSCC), a bioinformatics algorithm based on the gene co-expression network analysis was proposed in this study.

Firstly, differentially expressed genes (DEGs) were identified and a gene co-expression network (i-GCN) was constructed with Pearson correlation analysis. Then, the gene modules were identified with 5 different community detection algorithms, and the correlation analysis between gene modules and clinical indicators was performed. Gene Ontology (GO) analysis was used to annotate the biological pathways of the gene modules. Then, the key genes were identified with 2 methods, gene significance (GS) and PageRank algorithm. Moreover, we used the Disgenet database to search the related diseases of the key genes. Lastly, the online software onclnc was used to perform the survival analysis on the key genes and draw survival curves.

There were 2600 up-regulated and 1547 down-regulated genes identified in HNSCC. An i-GCN was constructed with Pearson correlation analysis. Then, the i-GCN was divided into 9 gene modules. The result of association analysis showed that, sex was mainly related to mitosis and meiosis processes, event was mainly related to responding to interferons, viruses and T cell differentiation processes, T stage was mainly related to muscle development and contraction, regulation of protein transport activity processes, N stage was mainly related to mitosis and meiosis processes, while M stage was mainly related to responding to interferons and immune response processes. Lastly, 34 key genes were identified, such as CDKN2A, HOXA1, CDC7, PPL, EVPL, PXN, PDGFRB, CALD1, and NUSAP1. Among them, HOXA1, PXN, and NUSAP1 were negatively correlated with the survival prognosis.

HOXA1, PXN, and NUSAP1 might play important roles in the progression of HNSCC and severed as potential biomarkers for future diagnosis.
Echocardiographic evaluation of left ventricular end diastolic pressure in patients with diastolic heart failure
Authors: Zhang Fen , Liang Yi , Chen Xinxin , Xu Liangjie , Zhou Cuicui , Fan Tingpan , Yan Jinchaun
Published: December 2020

To evaluate the left ventricular end diastolic pressure (LVEDP) in patients with diastolic heart failure by echocardiography and explore the clinical value of echocardiography.

From July 2017 to January 2018, 120 patients were prospectively selected from the affiliated hospital of Jiangsu university diagnosed as diastolic heart failure (York Heart Association class ≥II, LVEF ≥50%). The patients were divided into group with LVEDP ≤15 mm hg (1 mm hg = 0.133 kpa) (43 cases) and the group with LVEDP >15 mm hg (77 cases) according to the real-time measurement of LVEDP. Receiver operator characteristic curves of each parameter of echocardiography in diagnosis of LVEDP were compared between the 2 groups.

Common ultrasonic parameters such as left ventricular inflow tract blood flow propagation velocity, mitral valve diastole e peak velocity/mitral valve diastole a peak velocity, e peak deceleration time, a peak duration, and early diastole interventricular septum bicuspid annulus velocity e’ (e'sep) were used to evaluate LVEDP elevation with low accuracy (AUC is only between 0.5 and 0.7). Other ultrasonic parameters such as left atrial volume index (LAVI), tricuspid regurgitation maximum flow rate (TRmax), early diastole left ventricular sidewall bicuspid annulus velocity e’ (e’lat), average e’, E/e'sep, E/e’lat, average E/e’ were used to evaluate LVEDP elevation with a certain improvement in accuracy (AUC between 0.7 and 0.9). Propagation velocity, mitral valve diastole e peak velocity/mitral valve diastole a peak velocity, e peak deceleration time, a peak duration, e'sep, average e’, E/e'sep have very low correlation with LVEDP (r = −0.283 to 0.281); LAVI, TRmax, e’lat, E/e’lat, average E/e’ and LVEDP are not highly correlated (r = 0.330–0.478). Through real-time left ventricular manometry, multiple regression analysis showed that TRmax, average e’, e’lat, LAVI were independently correlated with the actual measured LVEDP.

Echocardiography can recognize the increase of LVEDP in patients with heart failure preserved by LVEF, and estimate the value of LVEDP roughly, which can reflect LVEDP to a certain extent, with high feasibility and accuracy.
Corona Virus Disease 2019 patients with different disease severity or age range
Authors: Ren Lingyun , Yao Dan , Cui Zuowei , Chen Shanshan , Yan Hong
Published: December 2020

This study aimed to describe clinical characteristics and prognosis of Corona Virus Disease 2019 (COVID-19) patients, and to compare these features among COVID-19 patients with different disease severity or age range.

Totally, 129 COVID-19 patients were retrospectively enrolled, and the information about demographics, comorbidities, medical histories, clinical symptoms, and laboratory findings at the time of hospital admission were collected. Meanwhile, their clinical outcomes were recorded. According to the fourth version of the guidelines on the Diagnosis and Treatment of COVID-19 by the National Health Commission of China, patients were divided into subgroups according to disease severity (moderate and severe/critical) or age (<40 years, 40–64 years and ≥65 years).

In total patients, the most common clinical symptoms were fever and cough (all incidences over 50%). Other common clinical symptoms included tiredness/anorexia, shortness of breath, dyspnea, aching pain, expectoration, diarrhea, shivering, and nausea/vomiting. The mortality rate was 5.4%, and the median value of hospital stay was 16.0 (11.0–23.0) days. Subgroup analyses disclosed that severe/critical patients exhibited increased neutrophil count, neutrophils, C-reactive protein, calcitonin, alpha-hydroxybutyric dehydrogenase, lactate dehydrogenase, aspartate aminotransferase, gamma-glutamyl transferase, creatinine, and D-dimer levels, and more deaths compared with that in moderate patients. Regarding age, it correlated with more common fever, higher levels of red blood cell, neutrophil count, lymphocyte count, neutrophils, red cell volume distribution width standard deviation-coefficient of variation, calcitonin, alpha-hydroxybutyric dehydrogenase, Creatine Kinase, aspartate aminotransferase, gamma-glutamyl transferase, and D-dimer, raised death rate and prolonged hospital stay.

Our findings provide valuable evidence regarding clinical characteristics and prognosis of COVID-19 patients to help with the understanding of the disease and prognosis improvement.
Chinese herbal medicine on treating obese women with polycystic ovary syndrome
Authors: Ding Ning , Yue Rensong , Wang Lizhen , Yang Hongjing
Published: December 2020

Introduction:

Known as an endocrine disorder, Polycystic ovary syndrome (PCOS) has posed an influence on 6% to 20% reproductive females worldwide. The commonly used pharmaceutical agents currently are Oral Contraceptives (OCs) and insulin-sensitizing agents. However, OCs is not appropriate for females pursuing pregnancy. Furthermore, some of insulin-sensitizing agents are found to be related to a high incidence of gastrointestinal adverse effects. In this regard, the effectiveness of Chinese herbal medicine in handling reproductive and metabolic defects simultaneously has been proved by extensive evidence. In this research, the effectiveness and safety of Chinese herbal medicine for obese females with PCOS were examined.

Methods and analysis:

In the systematic review, we searched databases of AMED, Science Online, EMbase, WorldSciNet, the Cochrane Library, PubMed, Nature, MEDLINE, China National Knowledge Infrastructure, the Wanfang Databse and China Biology Medicine Disc and the Chongqing VIP Chinese Science and Technology Periodical Database, to find out the papers published in Chinese or English by September 25, 2020 in this field. In addition, potential reference lists, relevant conference proceedings, qualified studies, related system reviews and other resources were also considered. Two researchers were responsible for independently selecting the research papers, collecting data, and evaluating research quality. Moreover, the data were synthesized with the combination of a fixed-effects or random-effects model with the heterogeneity test. According to the objective and self-reported assessment, the primary outcomes will be Nausea and vomiting were primary outcomes. RevMan 5 software was used to analyze the collected data, the evidence level of which was evaluated by GRADE. The selection between the fixed-effects and random-effects models was determined by the heterogeneity level. In addition to the 95% Confidence Interval (CI), odds ratio (OR), or risk ratio (RR) was applied to the 2 categories. Moreover, 95% CI and standardized mean difference (SMD) or the weighted mean difference (WMD) were taken as the continuous variables. When existing meaningful heterogeneity could not be explained by any assessment such as subgroup analysis, we would not conduct a meta-analysis. During the subgroup analysis, each subgroup in specific cases should be comprehensively considered.

Ethics and dissemination:

The evaluation of rights or personal information of patients was not involved in the systematic review. Hence, we need not gain approval from ethical institutions. This paper will be present at related conferences for communication and published in journals.

Registration:

Open Science Framework (OSF) Preregistration: osf.io/yp86h.
The safety and efficacy of endoscopic endonasal approach in the treatment of recurrent craniopharyngioma
Authors: Li Pengtao , Axier Aximujiang , Li Shaoshan , Zhou Kai , Yun Jingwei , Wang Huayi , Zhang Tingrong
Published: December 2020

Background:

Craniopharyngioma is the most challenging brain tumor with a high recurrence rate. Some scholars have shown that endoscopic endonasal approach (EEA) can achieve a higher total tumor resection rate and significantly reduce the incidence of complications and mortality. However, there is still no consensus on the surgical approach for recurrent craniopharyngioma. The purpose of this study is to evaluate the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.

Methods:

We will search 7 electronic databases (PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, AMED, Scopus) to collect related randomized controlled trials (RCTs). The resection rate, recurrence rate and progression-free survival rate will be regarded as the primary outcome, and the incidence of complications will be regarded as the secondary outcome. Endnote Software X9.0 will be used to filter articles, Review Manager Software 5.2 and STATA software 16.0 will be used for analysis and synthesis.

Results:

We will integrate existing studies to assess the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.

Conclusion:

Our study will provide EEA as an effective and safe treatment for recurrent craniopharyngioma.

Registration number:

International Prospective Register of Systematic Reviews (PROSPERO): CRD42020199860
The efficacy and safety of Yuxingcao eye drops in the treatment of COVID-19 conjunctivitis
Authors: Wu Jiajun , Pu Liqu , Zhou Hui , Qu Wenjia , Zhao Dandan , Liu Chunmeng , Dong Xuewen , Zhang Fuwen
Published: December 2020

Background:

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). There is no specific cure for this disease, and the clinical management mainly depends on supportive treatment. This disease may affect SARS-CoV-2 conjunctivitis. Yuxingcao eye drops is used in treating COVID-19 conjunctivitis in China.

Methods:

A comprehensive literature search will be conducted. Two methodological trained researchers will read the title, abstract, and full texts and independently select the qualified literature according to inclusion and exclusion criteria. After assessment of the risk of bias and data extraction, we will conduct meta-analyses for outcomes related to COVID-19 conjunctivitis. The heterogeneity of data will be investigated by Cochrane X2 and I
2 tests. Then publication bias assessment will be conducted by funnel plot analysis and Egger test.

Results:

The results of our research will be published in a peer-reviewed journal.

Conclusion:

Our study aims to systematically present the clinical evidence of Yuxingcao eye drops in treating COVID-19 conjunctivitis, which will be of significant meaning for further research and clinical practice.

PROSPERO registration number:

PROSPERO CRD42020209059.
Identification of candidate biomarkers correlated with the pathogenesis and prognosis of breast cancer via integrated bioinformatics analysis
Authors: Liu Shuyu , Liu Xinkui , Wu Jiarui , Zhou Wei , Ni Mengwei , Meng Ziqi , Jia Shanshan , Zhang Jingyuan , Guo Siyu , Lu Shan , Li Yingfei
Published: December 2020

Background:

This study was carried out to identify potential key genes associated with the pathogenesis and prognosis of breast cancer (BC).

Methods:

Seven GEO datasets (GSE24124, GSE32641, GSE36295, GSE42568, GSE53752, GSE70947, GSE109169) were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between BC and normal breast tissue samples were screened by an integrated analysis of multiple gene expression profile datasets. Hub genes related to the pathogenesis and prognosis of BC were verified by employing protein–protein interaction (PPI) network.

Results:

Ten hub genes with high degree were identified, including CDK1, CDC20, CCNA2, CCNB1, CCNB2, BUB1, BUB1B, CDCA8, KIF11, and TOP2A. Lastly, the Kaplan–Meier plotter (KM plotter) online database demonstrated that higher expression levels of these genes were related to lower overall survival. Experimental validation showed that all 10 hub genes had the same expression trend as predicted.

Conclusion:

The findings of this research would provide some directive significance for further investigating the diagnostic and prognostic biomarkers to facilitate the molecular targeting therapy of BC, which could be used as a new biomarker for diagnosis and to guide the combination medicine of BC.
Standardized nursing and clinical efficacy of OxyContin in reducing oral mucosal pain in patients with nasopharyngeal carcinoma
Authors: Sun Nina , Li Yunxia , Nie Peihua
Published: December 2020

Background:

Pain caused by oral mucositis (OM) is the main problem in the process of concurrent chemoradiotherapy for the nasopharyngeal carcinoma (NPC). This protocol aims to explore the standardized nursing and therapeutic effect of OxyContin on OM pain in the patients with NPC undergoing the concurrent chemoradiotherapy.

Methods:

The experiment is a randomized clinical research, which was granted through the Research Ethics Committee of Shandong Provincial Third Hospital (No.20200802097). In this research, 90 NPC patients with OM induced by chemotherapy are enrolled, and the score of visual analogue >5 and the grade of OM >1 are evaluated. Patients with known allergy to OxyContin, the opioid abuse history, or major organ dysfunction, for instance, hepatic insufficiency, renal failure, and respiratory and heart failure, as well as a series of severe mental illness are excluded from our research. Patients in study groups receive standardized nursing and oral OxyContin. Patients in control groups only receive oral OxyContin. The analgesic effect could be assessed with the comparison of the visual analogue scale after and before the treatment. Safety evaluations contain the assessment of the vital signs, laboratory tests, as well as adverse events. The Karnofsky performance status standards of the International Cancer Control Union is utilized to evaluate the quality of life.

Results:

The comparison of outcomes after taking OxyContin in both groups will be shown in Table 1

.

Conclusion:

The combination of OxyContin and standardized nursing care appears to improve the analgesic efficacy and life quality in NPC patients.

Trial registration: We registered this protocol in Research Registry (researchregistry6098).
The efficacy of platelet-rich plasma in arthroscopic rotator cuff repair
Authors: Xue Yi , Lu Tong , Xu Yue , Cao Xi
Published: December 2020

Background:

Platelet-rich plasma (PRP), an autologous platelet concentrate (contain a large number of growth factors), has been widely investigated in healing and rebuilding the bone and tendon tissue. The objective of this prospective randomized research is to study and then compare the long-term effectiveness of the repair of arthroscopic rotator cuff without and with the platelet-rich plasma. It is assumed that there is no difference in the clinical results between patients receiving the repair of arthroscopic rotator cuff and the patients who do not receive PRP enhancement.

Methods:

This current study is a prospective, single-center, controlled, and randomized experiment. This study was reviewed and permitted via the institutional review committee of our hospital. All the patients will receive the written informed consent in order to involve in our clinical experiment. Patients were selected from the patients who received the repair of arthroscopic rotator cuff. Patients who meet the following conditions will be included in this study: ages ranges from 18 to 55; patients with complete tear of rotator cuff confirmed during operation; the patients agreed to wear the abduction stent for 4 weeks after operation; the preoperative count of platelet count is >150,000. All patients were evaluated at follow-up and baseline for the scores of Constant-Murley (CM) and American Shoulder and Elbow Surgeons (ASES), the numerical rating scale (NRS), and retear rate. The analysis is implemented with the SPSS 16.0 (SPSS Inc., Chicago, IL), the significance level remain at P < .05.

Conclusions:

The results of this study will provide useful new information on whether PRP is effective in the arthroscopic rotator cuff repair patients.

Trial registration:

This study protocol was registered in Research Registry (researchregistry6108).
Efficacy and safety of Maxing Shigan Decoction in the treatment of chronic obstructive pulmonary disease
Authors: Chen Jinyun , Wang Chunrong , Xiong Min , Shen Qilin
Published: December 2020

Background:

Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world but is projected to be the 3rd leading cause of death by 2030. Chronic obstructive pulmonary disease is an important public health challenge, which can be prevented and treated. COPD is an important public health challenge, both preventable and treatable. In China, Maxing Shigan Decoction (MSD) has been used as a traditional Chinese medicine compound for the treatment of respiratory diseases for thousands of years. In order to evaluate the efficacy and safety of MSD in the treatment of COPD, we need to conduct meta-analysis and systematic reviews.

Methods:

The data comes from 7 publicly published databases, including: PubMed, The Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database(CBM), VIP Database, and Wanfang database. We will include randomized controlled trials (RCTs) to evaluate the effectiveness and safety of MSD in the treatment of COPD. Result measurement indicators include: TCM syndrome scores, lung function indicators, serum inflammatory factors, blood gas indicators, adverse reactions. RevMan 5.0 will be used for meta-analysis.

Results:

This study will provide high-quality evidence for the effectiveness and safety of traditional Chinese medicine therapy for COPD.

Conclusion:

The results of this study will help us determine whether MSD can effectively treat COPD.

Ethics and dissemination:

All analyses in this study are based on previously published research, so this study does not require ethical approval or patient consent. We will disseminate our findings electronically or in print by publishing results in peer-reviewed journals.

OSF registration number:

DOI 10.17605/OSF.IO/H5UNB.
Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy
Authors: Tekeli Arzu Esen , Oğuz Ali Kendal , Tunçdemir Yunus Emre , Almali Necat
Published: December 2020

Background:

Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy.

Methods:

The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 μg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses.

Results:

In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation.

Conclusion:

Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.