bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of the systemic inflammation response index in human malignancy
Authors: Wei Lishuang , Xie Hailun , Yan Ping
Published: December 2020

Background:

This meta-analysis aimed to evaluate the prognostic value of the systemic inflammation response index (SIRI) in malignancy based on existing evidence.

Methods:

We searched for relevant literature published in the electronic databases PubMed, Web of Science, Cochrane Library, and Embase before April 10, 2020. Hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated and pooled to evaluate the relationship between SIRI and malignancy outcomes.

Results:

We included 14 articles, describing 6,035 patients. Our findings revealed that patients with high SIRI had worse overall survival (OS) (HR = 2.20, 95% CI: 1.85–2.62, P < .001), disease-free survival (DFS) (HR: 1.92, 95% CI: 1.49–2.48, P < .001), time-to-progression (TTP) (HR: 2.00, 95% CI: 1.55–2.58, P < .001), progression-free survival (PFS) (HR: 1.73, 95% CI: 1.38–2.16, P < .001), cancer-specific survival (CSS) (HR: 3.57, 95% CI: 2.25–5.68, P < 0.001), disease-specific survival (DSS) (HR: 1.99, 95% CI: 1.46 - 2.72, P < .001), and metastasis-free survival (MFS) (HR: 2.26, 95% CI: 1.28–3.99, P = .005) than patients with low SIRI. The correlation between SIRI and OS did not change in a subgroup analysis. Meta-regression indicated that heterogeneity may be related to differences in primary therapy strategies. Sensitivity analysis suggested that our results were reliable.

Conclusions:

SIRI could be used as a useful predictor of poor prognosis during malignancy treatment.
Predictive value of Alberta stroke program early CT score for perfusion weighted imaging - diffusion weighted imaging mismatch in stroke with middle cerebral artery occlusion
Authors: Xu Kaixi , Gu Baodong , Zuo Taosheng , Xu Xingru , Chen Yu-Chen , Yin Xindao , Feng Guangkui
Published: December 2020

This study aimed to quantitatively assess the consistency and correlation between perfusion weighted imaging (PWI)/ diffusion weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) mismatch and PWI/DWI mismatch.

Sixty-eight acute ischemic stroke with middle cerebral artery occlusion who underwent magnetic resonance imaging before thrombectomy were eligible. DWI volume, PWI volume and PWI-DWI mismatch were measured. DWI-, PWI-, PWI-DWI ASPECTS were evaluated. Statistical analysis was performed to compare the correlation between volume and ASPECTS of DWI-, PWI- and PWI-DWI mismatch. Receiver operating characteristic curve analysis was used to assess the predictive value of the PWI-DWI ASPECTS mismatch for the occurrence of PWI-DWI mismatch in acute ischemic stroke patients with middle cerebral artery occlusion.

Of 68 patients, the DWI volume, PWI volume and PWI-DWI mismatch volume were (27.76 ± 17.53) mL, (167.09 ± 59.64) mL and (139.33 ± 58.18) mL respectively. DWI-ASPECTS was 6.75 ± 1.90 with the interobserver agreement was κ=0.98 (95% CI, 0.95–0.99); PWI-ASPECTS was 3.09 ± 2.11 with the interobserver agreement was κ=0.95 (95% CI, 0.91–0.99); PWI-DWI ASPECTS mismatch was 6.75 ± 1.90. Spearman's rank correlation analysis revealed that PWI-DWI mismatch volume was negatively correlated with PWI-DWI ASPECTS mismatch (r = −0.802; P = .000). Receiver operating characteristic analysis showed that when the PWI-DWI ASPECTS mismatch cut point was ≥ 2, the under curve of PWI-DWI ASPECTS mismatch for predicting PWI-DWI mismatch was 0.954 (95%CI, 0.911–0.998), with the sensitivity and specificity were 84.00% and 100% respectively.

PWI-DWI ASPECTS mismatch may represent a convenient surrogate for penumbra in clinical trials.
Intracranial solitary fibrous tumor mimicking meningioma
Authors: Cheng Longyang , Ni Hongbin , Dai Yuxiang
Published: December 2020

Rationale:

Solitary fibrous tumor is a rare mesenchymal tumor. This case report describes the diagnosis and treatment of this tumor.

Patient concerns:

A 31-year-old patient presented with epileptic seizure and headache 1 day prior to the visit and showed transient right limb hemiplegia for 6 hours that was resolved after intravenous infusion of mannitol.

Diagnoses:

Based on imaging, the provisional diagnosis was meningioma. Postsurgical histopathological diagnosis confirmed solitary fibrous tumor.

Interventions:

The lesion was totally excised. The patient improved remarkably after the operation, without any signs of associated limb movement disorder. No epileptic seizure was observed or reported after the operation.

Outcomes:

Postoperation computed tomography (CT) scans showed no obvious residual tumor. The patient was followed up every 3 months for a total of 1 year following the operation, during which time the patient did not complain of headache or seizure.

Lessons:

The manifestation of solitary fibrous tumor (SFT) through imaging methods has certain specific findings,butimmunohistochemistry is still very important for confirming the diagnosis.
Intravenous versus oral acetaminophen as an adjunct on pain and recovery after total knee arthroplasty
Authors: Teng Yanbin , Zhang Yan , Li Baojie
Published: December 2020

Background:

Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, intravenous (IV) versus oral acetaminophen (APAP) treatment is still a controversial subject in TKA. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of IV versus oral APAP on pain and recovery after TKA.

Methods:

Embase, Pubmed, and Cochrane Library were comprehensively searched. Randomized controlled trials, cohort studies were included in our meta-analysis. Five studies that compared IV APAP groups with oral APAP groups were included in our meta-analysis. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines to ensure the reliability and verity of results.

Results:

Pooled results indicated that no significant difference between the IV APAP groups and oral APAP groups in term of VAS score at 24 hours (P = .67), 48 hours (P = 0.08), and total morphine consumption at 24 hours (P = .07), but there was a significant difference in terms of length of hospital stay (LOS) (P = .0004).

Conclusion:

IV APAP was not found to be superior to oral APAP in patients undergoing TKA in terms of VAS scores at 24 hours, 48 hours, and total morphine consumption at 24 hours. However, it can significantly reduce the LOS. We still need a large of high-quality research to verify the relationship between the oral and the IV APAP to give the conclusion.
Correlative analysis between cytotoxic T lymphocyte antigen 4 genetic polymorphisms and head and neck cancer susceptibility
Authors: Lin Bo , Wang Ling
Published: December 2020

Background:

Previous published studies have reported the association of cytotoxic T lymphocyte antigen 4 (CTLA-4) genetic polymorphisms with the susceptibility to head and neck cancer, but the results remain controversial. We therefore will conduct a meta-analysis to investigate the relationship between CTLA-4 genetic polymorphisms and head and neck cancer susceptibility.

Methods:

We will systematically search case-control studies for potential eligible studies from Cochrane Library, EMBASE, Google Scholar, PubMed, China Biomedical Database, WanFang database, and China National Knowledge Infrastructure (CNKI). Additionally, we will also examine other sources to avoid missing potential trials. Two authors will independently collect and perform the study selection, data extraction, and study methodological quality. Statistical analyses were utilized using STATA 12.0 and RevMan 5.3, and the odds ratios (ORs) with 95% confidence intervals (95% CI) were used to estimate the strength of the association of CTLA-4 genetic polymorphisms with the susceptibility to head and neck cancer.

Results:

This protocol study will assess the relationship between CTLA-4 genetic polymorphisms and head and neck cancer susceptibility.

Conclusion:

The findings of this study will provide systematic evidence for future guidance developing and clinical decision making in patients with head and neck cancer.

Ethics and dissemination:

Ethical approval will not be required as this study is a systematic review.

Protocol registration number:

DOI 10.17605/OSF.IO/BFJTZ (https://osf.io/bfjtz/)
Multiple antiarrhythmic transplacental treatments for fetal supraventricular tachyarrhythmia
Authors: Chen Tingting , Yang Yanfeng , Shi Kun , Pan Yue , Wei Sumei , Yang Zexuan , Yang Xiao
Published: December 2020

Background:

Fetal supraventricular tachyarrhythmia is a common reason for referral to fetal cardiology. Multiple antiarrhythmic transplacental medications can be used to treat these diseases. Debates remain regarding the standardized therapy.

Methods:

PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov will be searched from inception to September 2020. A handsearching for gray literature, including unpublished conference articles, will be performed. The randomized control trials, case–control, and cohort studies will be accepted, no matter what the languages they were reported. We will first focus on the effectiveness of the therapy on fetal cardiac rhythm and/or heart rate. Then we will do further analysis of preterm delivery, fetal hydrops, intrauterine fetal demise, and maternal side effects. The Cochrane Risk of Bias Tool and the Newcastle–Ottawa scale will be used to assess the risk of bias of the randomized controlled trials, case–control, and cohort studies, respectively. Two independent reviewers will carry out literature identification, data collection, and study quality assessment. Discrepancies will be resolved by a third reviewer. Statistical analysis will be conducted using the STATA 13.0 software.

Result:

The results will provide helpful information about the effect of multiple antiarrhythmic transplacental therapies in pregnancies with supraventricular tachycardia or atrial flutter, and demonstrate which therapy is more effective.

Conclusion:

The conclusion drawn from this systematic review will benefit the patients with fetal supraventricular tachyarrhythmia.
Magnetic resonance imaging for the non-invasive diagnosis in patients with ovarian cancer
Authors: Su Yongxue , Deng Lingli , Yang Lijun , Yuan Xianhong , Xia Wei , Liu Ping
Published: December 2020

Background:

In developed nations, ovarian cancer has resulted in the most fatalities from gynecological cancer. Laparoscopy is primarily utilized as the test to diagnose ovarian cancer. Besides being costly, there are surgical risks associated with laparoscopies. At present, clinical practitioners have access to non-invasive tests for diagnosing ovarian cancer. This study aims to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for diagnosing ovarian cancer.

Methods:

In order to obtain eligible studies, cross-sectional studies or randomized controlled trials are searched in electronic databases. The databases include 5 English databases (PubMed, the Cochrane Library, PsycINFO, EMBASE, and Web of Science) and 3 Chinese databases (China Biomedical Literature Database, China National Knowledge Infrastructure, and WanFang database). The databases are searched from their origin to October 2020. Quality Assessment of Diagnostic Accuracy Studies-2 is used to assess the methodological quality of the selected studies. RevMan 5.3 and SAS NLMIXED software are used to assess the data synthesis, sensitivity analysis, and risk of bias assessment.

Results:

This study evaluates the pooled diagnostic value of MRI for diagnosing ovarian cancer.

Conclusions:

This study will summarize previously published evidence of MRI in relation to diagnosing ovarian cancer.

Ethics and dissemination:

Since this study does not utilize data from patients, this protocol does not require ethical approval.

Protocol registration number:

DOI 10.17605/OSF.IO/A6SPQ (https://osf.io/a6spq)
Nonpalpable breast masses
Authors: Wen Hongmei , Xu Tao , Huang Qinhua , Zhang Chumiao , Zhang Qi , Chen Haiyan
Published: December 2020

Women with nonpalpable breast masses are at a high risk of developing breast cancer (BC) due to misdiagnosis during the follow-up period.

A total of 40,334 women were divided into palpable and nonpalpable breast mass groups. We assessed the risk factors for cancer development in patients with nonpalpable breast masses during a 1-year follow-up period.

Of the 1335 patients in the nonpalpable breast mass group, we found 50 patients of BC, of which 35 patients accepted surgery and were confirmed with biopsy at the beginning of the study. The remaining 15 (1.1%) were diagnosed with BC during follow-up, and included 10 in situ and 5 invasive carcinomas. Four of the 10 patients in the in situ subgroup, and 2 out of the 5 in the invasive subgroup were overweight (Body mass index > 24 kg/m2). Nine in situ BC patients had breast-conserving surgery, 1 had a mastectomy. No patient in the in situ group received chemotherapy or radiotherapy. All 5 patients with invasive disease received 6 cycles of chemotherapy. Only 3 (20%) of the 15 patients with BC had a positive family history. We found 131 BC cases, including BC detected during screening (81) and follow-up (50). The incidence of BC was 240.2 per 100,000 inhabitants.

Patients with nonpalpable breast masses require regular follow-up as they have a high risk of cancer occurrence. Regular follow-up can lead to early diagnosis and effective treatment of these early-stage BC patients.
Effect of otago exercise on falls in patients with osteoarthritis
Authors: Xie Chao , Wang Weini , Pei Jingfang , Wang Haiyan , Lv Honglin
Published: December 2020

Background:

Osteoarthritis (OA) is considered as an established risk factor for falls, while exercise can effectively prevent falls. However, whether otago exercise can prevent falls in OA patients is still controversial. Based on sufficient clinical studies, this study aimed to apply meta-analysis to evaluate the effectiveness of otago exercise on preventing falls in OA patients with.

Methods:

PubMed, EMbase, Web of Science and Cochrane Library were searched to collect randomized controlled trial (RCT) of the effect of Otago exercise on falls in OA patients. The search time limit was from the establishment of the database to September 2020. After the 2 researchers independently screened the literature, the data was extracted and the bias risk included in the study was evaluated. Meta-analysis was carried out with RevMan 5.3software.

Results:

The results of our meta-analysis could be published in peer-reviewed journals.

Conclusion:

This study provided high-quality evidence to support the effect of Otago exercise on falls in OA patients.

OSF Registration number:

DOI 10.17605/OSF.IO/Z5XGV.
Prevention of oxaliplatin-related neurotoxicity by ω-3 PUFAs
Authors: Zhang Xinjie , Chen Haitao , Lu Yi , Xu Chao , Yao Wang , Xu Lu , Zhang Runzhe , Zhang Liping , Yao Qinghua
Published: December 2020

Background:

Peripheral neurotoxicity (PN) is a frequent side effect of oxaliplatin treatment, and also is its dose-limiting toxicity. Studies have confirmed that ω-3 polyunsaturated fatty acids (ω-3 PUFAs) had a neuroprotective effect. However, the efficacy of ω-3 PUFAs on the prevention of oxaliplatin-related neurotoxicity remains unclear. We assessed the effect of ω-3 PUFAs on the neurotoxicity in colon cancer patients treated by oxaliplatin combined with capecitabine.

Methods:

In a randomized, double-blind, placebo-controlled study, 179 patients with colon cancer receiving oxaliplatin combined with capecitabine were recruited, and randomly assigned to take ω-3 PUFAs, 640 mg t.i.d during chemotherapy and 1 month after the end of the treatment or placebo. All patients were treated with chemotherapy for 6 treatment cycles. The incidence and severity of PN were evaluated, and the nerve conduction was measured before the onset of chemotherapy and 1 month after treatment. In addition, the quality of life was also accessed using Chinese version of European organization for research and treatment of cancer quality of life questionnaire.

Results:

The incidence of PN in the ω-3 PUFAs group and placebo group was 52.22% and 69.66%, respectively (P = .017). In addition, there was a significant difference in the severity of PN between the 2 groups (P = .017). In terms of motor and sensory nerve conduction, the sensory action potentials amplitude of sural nerve in the ω-3 PUFAs group and placebo group after chemotherapy treatment were (15.01 ± 3.14) and (13.00 ± 3.63) μ V respectively, suggesting there was a significant difference in the 2 groups (P = .000). In addition, the mean score of the global health-status/quality of life was obviously higher in the ω-3 PUFAs group than that in the placebo group.

Conclusion:

ω-3 PUFAs seem to reduce the incidence and severity of oxaliplatin-related neurotoxicity, and improve the quality of patients’ life, indicating it is expected to be a potential drug for the treatment of oxaliplatin-related neurotoxicity.
Risk factors associated with relapse of adult-onset Still disease in Korean patients
Authors: Kang Ji-Hyoun
Published: December 2020

Approximately 30% to 40% of all patients with adult-onset Still disease (AOSD) experience relapses, sometimes presenting as chronic damage, and these events can subsequently increase the morbidity and mortality in patients with AOSD. However, few studies are investigating the factors related to relapse in such patients. Therefore, this study aimed to explore the risk factors associated with relapse of AOSD.

This cohort study enrolled 112 AOSD patients who satisfied the Yamaguchi criteria and obtained available data from Chonnam National University Hospital. The demographic, clinical, and laboratory data as well as treatment history of the patients from January 2008 to December 2019 were retrospectively reviewed. Relapse events were defined as the presence of one or more recurrent events. Multivariate logistic regression analysis was performed to investigate the possible risk factors for relapse.

During a mean follow-up of 103.3 months, 47 of 112 patients (41.9%) developed a relapse. According to the results of multivariate logistic regression analysis, arthritis (odds ratio [OR] = 19.530, 95% confidence interval [CI]: 5.047–75.582, P < .001) and lymphadenopathy (OR = 6.539, 95% CI: 2.329–18.358, P < .001) predicted the development of recurrent events in patients with AOSD.

Patients with AOSD had frequent relapses during the clinical course of their disease. Risk factors associated with flares were the presence of arthritis and lymphadenopathy.
Primary multiple angiosarcoma of vertebra
Authors: Huang Wei , Liu Tao , Duan Ruimeng , Yuan Yashuai , Qu Mingjia , Zhang Meng , Shang Depeng , Yu Xiaobing
Published: December 2020

Rationale:

Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra.

Patient concerns:

A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months.

Diagnoses:

Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra.

Interventions:

The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time.

Outcomes:

The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later.

Conclusion:

This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.
Efficacy and safety of warm needle acupuncture in knee osteoarthritis
Authors: Wei Ying , Yuan Nairong , Ding Jiru , Wang Lixia , Dong Yan , Deng Lu , Yang Qi
Published: December 2020

Background:

Knee osteoarthritis (KOA) is a chronic disease, which is also recognized as a common disease affecting the elderly. However, the application of Western medicine is limited in clinical because of its obvious adverse reactions. Warm needle acupuncture (WNA) has a long history in the treatment of KOA and is widely used in Chinese. Here we will submit a protocol to evaluate the efficacy and safety of WNA in the treatment of KOA.

Methods:

We will search 5 English databases (PubMed, MEDLINE, Embase, Cochrane Library, Web of Science), 4 Chinese databases [China National Knowledge Infrastructure (CNKI), China Biology Medicine, Chinese Science and Technology Journal Database (VIP), and Wanfang database] and grey literature for randomized controlled trials of WNA in the treatment of KOA. The primary outcome measure is Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the secondary outcome will include degree of knee flexion and adverse events caused by WNA, such as dizziness, nausea, abdominal pain, arrhythmia, etc. The selection of the literatures will be conducted by endnote X7 software, and we will use Review Manger V.5.3 software to conduct the meta-analysis.

Results:

This study will provide reliable evidence for WNA in the treatment of KAO.

Conclusion:

The conclusion of this study will testify the efficacy and safety of WNA in the treatment of KAO.

Registration:

OSF Preregistration. 2020, October 11; osf.io/bu5qw
The value of microRNA-203 as a biomarker for the prognosis of esophageal cancer
Authors: Wang Song , Yu Pingping , Meng Zhen , Feng Lin
Published: December 2020

Background:

Previous studies have reported that microRNA-203 has an effect on the prognosis of with esophageal cancer (EC). However, the conclusion is remains controversial. Therefore, this study will try to explore the effect of high expression of microRNA-203 on the prognosis of EC patients.

Methods:

Eligible studies were searched from Google Scholar, Embase, PubMed, Medline, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Scientific Journal Database, Chinese BioMedical Database and Wanfang Database. Papers in English or Chinese published from their inception to November 2020 will be included without any restrictions. Stata 14.0 and Review Manager 5.3 software were used for data analysis. Hazard ratios (HRs) and its 95% confidence intervals (CIs) were used to assess the prognostic effect of microRNA-203 on overall survival (OS) and disease-free survival (DFS). Methodological quality for each eligible trial will be assessed by using the Newcastle-Ottawa Quality Assessment Scale (NOS).

Results:

This study will provide a high-quality evidence-based medical evidence of the correlations between microRNA-203 expression and OS and DFS.

Conclusion:

The findings of this meta-analysis will show the effect of high expression of microRNA-203 on the prognosis of EC patients, and may find a new prognostic marker for EC.

INPLASY registration number:

INPLASY2020110022.
The effectiveness of iron supplementation for postpartum depression
Authors: Tian Yanran , Zheng Zeyu , Ma Chen
Published: December 2020

Background:

Postpartum depression (PPD) is one of the most common postpartum psychiatric disorders. The prevalence of PPD ranges from approximately 10% to 30%. In recent years, iron supplementation has emerged as potential means to treat PPD, and an increasing number of studies have been published to support the effectiveness of iron supplementation for PPD. we will conduct a comprehensive systematic review and meta-analysis to evaluate the evidence of randomized controlled trials for iron supplementation treatment of PPD.

Methods:

PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science, and Technology Journal Database, and Chinese Biomedical Literature Database will be searched from their inception of databases to December 31, 2020. Two reviewers will select articles, extract data and assess the risk of bias independently. Any disagreement will be resolved by discussion with the third reviewer. Review Manager 5.3 software will be used for data synthesis. The Cochrane risk of bias assessment tool will be used to assess the risk of bias.

Results:

This study will conduct a comprehensive literature search and provide a systematic synthesis of current published data to explore the effectiveness of iron supplementation for PPD.

Conclusions:

This systematic review and meta-analysis will provide clinical evidence for the effectiveness of iron supplementation for PPD, inform our understanding of the value of iron supplementation in improving PPD symptoms, and help clinicians to make better decisions regarding the appropriate role of iron supplementation as a part of prevention and treatment routines.

Study registration number:

INPLASY2020110007
Stiff-person syndrome coexisting with critical illness polyneuropathy
Authors: Cai Qiong , Wu Chao , Xu Wenxiao , Liang Yinxing , Liao Songjie
Published: December 2020

Rationale:

Stiff-person syndrome (SPS) is an uncommon neurological disorder with autoimmune features. Here, we report a 60-year-old man with SPS associated with critical illness polyneuropathy (CIP). CIP was diagnosed during an episode of acute respiratory failure secondary to muscular rigidity and spasms, which has rarely been reported in this condition. The overlapping of CIP and SPS complicated the case.

Patient concerns:

A 60-year-old man presented with gradual onset of cramps, stiffness, and rigidity in his lower limbs 1 year before admission, which eventually led to inability to stand and walk. The persistent nature of his symptoms progressed to frequent acute episodes of dyspnea and he was admitted to intensive care unit (ICU).

Diagnosis:

SPS had been diagnosed after 2 tests of electromyography (EMG) and the detection of an elevated anti-GAD65 antibody titer. During the first EMG, low or absent compound muscle action potentials (CMAP), and sensory nerve action potentials (SNAP) were shown. Therefore, the diagnosis of SPS coexisting with CIP was made.

Interventions:

Symptomatic treatment was initiated with oral clonazepam (0.5 mg Bid) and baclofen (5 mg Bid). Intravenous immunoglobulin (IVIG) (0.4 g/kg/d) was administered for the patient for 5 days after admission. We observed a significant clinical improvement during the administration period, and the patient became ambulatory.

Outcomes:

On follow-up, the patient reported complete relief of his pain and rigidity.

Lessons:

We report this special case to address the varied clinical features of SPS. Electrophysiological testing is an important diagnostic approach. Accurate recognition of the disease ensures that the patients can be given appropriate treatment without delay.
Intraoperative fluid management in hepato-biliary-pancreatic operation using stroke volume variation monitoring
Authors: Iwasaki Yudai , Ono Yuko , Inokuchi Ryota , Ishida Tokiya , Kumada Yoshibumi , Shinohara Kazuaki
Published: December 2020

Trial design:

This investigator-initiated, single-center, open-label, parallel-group, randomized-controlled pilot study was designed to compare the intraoperative fluid balance and perioperative complications in patients undergoing hepato-biliary-pancreatic surgery with or without stroke volume variation (SVV)-guided fluid management.

Methods:

Patients who were aged >18 years and underwent elective major hepato-biliary-pancreatic surgery between June 30, 2015, and August 31, 2016 at our center were randomly assigned to receive SVV-guided or conventional fluid therapy. The intervention group used SVV to determine the patients’ volume status. The primary outcome was the total fluid balance per body weight per operation time, and the secondary outcomes were the total amount of intravenous infusion per body weight per operation time and the Sequential Organ Failure Assessment score on postoperative day 1. Patients were randomized by a two-block computer-generated assignment sequence. Masking of patients and assessors was conducted. The patients and assessors were each blinded to the details of the trial; however, the clinicians were not.

Results:

Of the 69 patients who were initially eligible, 60 provided informed consent for participation in the study. After randomization, three patients dropped out of the study because of deviations from the protocol or unexpected hypotension, leaving 28 and 29 patients in the intervention and control groups, respectively. Patients in both groups had similar characteristics at baseline. The median (interquartile range [IQR]) intraoperative fluid balance in the control and SVV groups was 6.2 (IQR, 4.9–7.9) and 8.1 (IQR, 5.7–10.5) ml/kg/h, respectively (P = .103). The administered intravenous infusion was significantly higher in the SVV group (median, 10.9; IQR, 8.3–15.3 ml/kg/h) than in the control group (median, 9.5; IQR, 7.7–10.3 ml/kg/h) (P = .011). On postoperative day 1, the PaO2/FiO2 ratio was lower in the SVV group (median, 266; IQR, 261–341) than in the control group (median, 346; IQR, 299–380) (P = .019).

Conclusions:

Use of the SVV-guided fluid management protocol did not reduce intraoperative fluid balance but increased the intraoperative fluid administration and might worsen postoperative oxygenation.

Trial registration:

UMIN000018111.
Different impacts of various tocolytic agents on increased risk of postoperative hemorrhage in preterm labor women undergoing Cesarean delivery
Authors: Lee Hua-Lin , Lu Kuo-Ching , Foo Jossen , Huang I-Tao , Fan Yen-Chun , Tsai Pei-Shan , Huang Chun-Jen
Published: December 2020

Tocolytic agents, commonly used for inhibiting preterm labor, pose the risk of uterine atony, leading to postpartum hemorrhage. This study elucidated the effects of different tocolytic agents on postoperative hemorrhage among women in preterm labor undergoing Cesarean delivery (CD). Data from Taiwan National Health Insurance Research Database were analyzed. The risk (adjusted hazard ratio [aHR] and 95% confidence intervals [CI]) of postoperative hemorrhage in CD women with preterm labor diagnosis using tocolytic agents (Tocolysis group) comparing to CD women not using tocolytic agents (Control group) were determined. Impacts of different tocolytic agents in this regard were also investigated. Our data revealed that the incidence (11.7% vs 2.6%, P < .001) and risk (aHR: 1.21, 95% CI: 1.12–1.31, P < .001) of postoperative hemorrhage were significantly higher in the Tocolysis group (n = 15,317) than in the Control group (n = 244,096). Ritodrine was the most frequently used tocolytic agent (80.5%), followed by combination therapy (using more than one tocolytic agents) (8.5%), magnesium sulfate (MgSO4, 4.6%), calcium channel blockers (3.8%), betamimetics other than ritodrine (1.9%), prostaglandin synthase inhibitors (0.5%), and nitrates (0.1%). Barring those using calcium channel blockers and combination therapy, the use of MgSO4 (aHR: 1.43, P = .001), betamimetics other than ritodrine (aHR: 1.71, P < .001), prostaglandin synthase inhibitors (aHR: 2.67, P < .001) and nitrates (aHR: 3.30, P = .001) was associated with higher risks of postoperative hemorrhage compared with ritodrine. In conclusion, CD women with preterm labor diagnosis using tocolytic agents exhibit an increased risk of postoperative hemorrhage and that this risk varies with the use of different tocolytic agents.
Association of interleukin-6 gene polymorphisms with the risk of hepatocellular carcinoma
Authors: An Pei-Pei , Feng Li-Na , Zhang Xiao-Xue , Jin Qing-Long
Published: December 2020

Background:

This study was aimed to evaluate the association between interleukin-6 (IL-6) gene polymorphisms and the risk of hepatocellular carcinoma (HCC) in a meta-analysis.

Methods:

A literature search was performed for case-control studies published during May, 1993 to May, 2020 focusing on IL-6 gene polymorphisms (–174G > C, –572G > C, and –597G > A) and HCC susceptibility by using PubMed, Cochrane Database, EMBASE, Web of science, and China National Knowledge Infrastructure. From 128 full-text articles, 11 were included in this meta-analysis. I2 index was used to assess heterogeneity and Newcastle-Ottawa Scale was utilized for quality assessment.

Results:

For IL-6 –174G > C polymorphism, in codominant (GG vs CC: odds ratios [OR] = 2.78, 95% confidence intervals [CI] = 1.25–6.19, P = .01, I2 = 16%) and recessive (GG+GC vs CC: OR = 2.76, 95% CI = 1.29–5.90, P = .009, I2 = 3%) models, IL-6 –174G>C polymorphism was significantly associated with the risk of HCC. In dominant (GG vs CC+GC: OR = 1.80, 95% CI = 0.92–3.54, P = .09, I2 = 86%) and allele (G vs C: OR = 1.49, 95% CI = 0.95–2.32, P = .08, I2 = 68%) models, IL-6 –174G>C polymorphism had no impact on the risk of HCC. However, in non-Italian Caucasian population, IL-6 –174G>C polymorphism was significantly related to the occurrence of HCC in both dominant (GG vs CC+GC: OR = 3.26, 95% CI = 2.29–4.65, P < .00001, I2 = 0%) and allele (G vs C: OR = 2.48, 95% CI = 1.48–4.15, P = .0006) models. Such correlations also could be observed when healthy individuals were selected as controls. For IL-6 –572G>C and –597G>A polymorphisms, no significant association was observed in all models, regardless of the source of control and population subgroups. No publication bias could be calculated when Begg and Egger tests were employed.

Conclusion:

This meta-analysis indicated that IL-6 –174G>C polymorphism was significantly related with the risk for HCC, especially in non-Italian Caucasian population. No significant association was observed for the correlation between IL-6 –572G>C and –597G>A polymorphisms and HCC susceptibility.
Dexmedetomidine as an adjuvant for patients undergoing breast cancer surgery
Authors: Liu Changjun , Wang Wei , Shan Zhengkun , Zhang Huapeng , Yan Qiang
Published: December 2020

Background:

The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis.

Methods:

Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software.

Results:

Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = −0.65) and morphine (total: SMD = −2.23; patient-controlled analgesia: SMD = −1.45) as well as intraoperative requirement for fentanyl (SMD = −1.60), and lower the pain score at 1 (SMD = −0.30), 2 (SMD = −1.45), 4 (SMD = −2.36), 6 (SMD = −0.63), 8 (SMD = −2.47), 12 (SMD = −0.81), 24 (SMD = −1.78), 36 (SMD = −0.92), and 48 (SMD = −0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05).

Conclusion:

DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.
Staged treatment and internal fixation of floating ankle
Authors: Yao Jihang , Jin Tao , Song Chengfu , Ju Weina , Tian Zhisen , Qi Baochang , Wang Yuanyi
Published: December 2020

Rationale:

Floating ankle is a rare traumatic condition characterized by a combination of tibial and ipsilateral foot fractures, with the ankle remaining intact. It is usually caused by high-energy trauma and also presents with serious soft tissue damage. Its treatment is mainly restricted to external fixation, which results in poor outcomes. We present a patient with a floating ankle who underwent staged treatment and achieved full internal fixation, subsequently returning to normal activity.

Patient concerns:

A 26 year- old man had an accident with an reel machine and sustained an open fracture on his right lower extremity.

Diagnoses:

Digital radiograph demonstrated a distal tibial fracture, fibular fracture, and multiple metatarsal fractures, which fulfilled the criteria for a floating ankle.

Interventions:

Initial ankle-spanning external fixation was performed. After 21 days, the patient underwent open reduction and internal fixation on his first and fifth metatarsals, and K-wire fixation on his fourth metatarsal. The external fixator was replaced by plaster fixation. Seven days later, the patient underwent internal fixation of his leg, open reduction and internal fixation with plating was applied of the fibular fracture, and minimally invasive plate osteosynthesis of the tibial fracture.

Outcomes:

At 1-year follow-up, bone union was identified by digital radiograph; after 2 years, his ankle function had fully recovered, and he resumed his normal activities.

Lessons:

In the staged treatment protocol of the floating ankle, temporary external fixation provided traction and immobilization of the skeletal and soft tissues. Secondary internal fixation maintained the reduction and alignment and allowed early exercise, which is critical to the prognosis of a floating ankle.
Safety of locating the tip of a medium-long catheter at the axillary front and clavicle midline
Authors: Zhao Yali , Geng Jie , Wu Xing , Xiong Suiting , Wang Liwei , Wang Juanxia , Ma Haijv , Wei Fengxian , Wei Zhihong
Published: December 2020

Background:

Medium-long catheters are being used more and more widely in clinical practice, but we still do not know the impact of different placements, but this is an important clinical issue that cannot be ignored.

Objective:

At present, the tip positioning of the mid-length catheter mainly includes the anterior part of the axilla and the midclavicular line. Different positioning may have different effects. Therefore, we did this research to confirm which positioning is more safety.

Methods:

We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, China Knowledge Network, China Biomedical Literature Database, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use Stata to carry out meta-analysis.

Results:

This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.

Ethics and dissemination:

Ethical approval is not applicable, since this is an overview based on published articles.

Protocol registration number:

INPLASY2020110042
Error analysis of collimated and uncollimated SeHCAT retention measurement using a gamma camera
Authors: James Gregory , Notghi Alp , O’Brien Joseph , Thomson William
Published: December 2020

Aim

There is increasing interest in using collimated gamma cameras for [75Se]tauroselcholic acid (SeHCAT) studies to image the distribution and to make use of the collimator pressure sensitive devices (PSD) for patient safety. However, the use of a collimator will substantially decrease the sensitivity of the gamma camera. The aim of this article is to enable departments to calculate the uncertainty of SeHCAT retention measurements so that the acquisition time can be optimised to perform a reliable SeHCAT study.

Method

We derive a mathematical equation from the first principles that can be used to calculate the uncertainty in SeHCAT retention measurements on the basis of Poisson counting statistics. The equation takes account of background subtraction, use of the geometric mean for anterior/posterior attenuation compensation and the day 7 to day 0 quotient calculation.

Results

Uncertainties in SeHCAT retention measurement using an intrinsic (uncollimated) gamma camera counting for 100 s are very low, typically of the order 15 ± 0.1%. Uncertainties from collimated gamma camera counting significantly increase for the same 100 s counting duration: 15 ± 0.8% for slim patients and 15 ± 4% for obese patients.

Conclusion

The acquisition time must be increased for collimated gamma camera SeHCAT counting to achieve acceptable counting statistics for an acceptable total uncertainty in the SeHCAT retention measurement. For slim patients, a minimum counting time of 2 min is required. For larger patients, the acquisition time needs to be increased to 30 min and further increased to 50 min for obese patients.
99mTc-antitumor necrosis factor-alpha scintigraphy for the detection of inflammatory activity in rheumatoid arthritis
Authors: Alexandre Dângelo J. A. , Carmo Clarissa C. M. , Romeiro Leonardo D. , Gutfilen-Schlesinger Gabriel , Amarante José L. M. , de Souza Sergio A. L. , Gutfilen Bianca
Published: December 2020

Objective

Tumor necrosis factor-alpha (TNF-α) is an important inflammatory cytokine. 99mTc-anti-TNF-α antibody scintigraphy has proven to be a viable alternative to MRI in specific cases. The objective of this study was to evaluate the performance of scintigraphy with 99mTc-anti-TNF-α in the identification of inflammatory foci in individuals diagnosed with rheumatoid arthritis using MRI as the gold standard.

Methods

This cross-sectional, descriptive and analytical-qualitative clinical study compared the performance of 99mTc-anti-TNF-α scintigraphy with that of MRI with intravenous administration of gadolinium (used as the gold standard) and a clinical examination (Disease Activity Score 28) in 220 joints of 20 patients with a diagnosis of rheumatoid arthritis and one healthy control.

Results

The concordance of scintigraphy with MRI in individuals with a diagnosis of rheumatoid arthritis was 79%. The accuracy, sensitivity and specificity of scintigraphy for distinguishing between inflammatory and noninflammatory sites were 92, 89, and 93%, respectively. No adverse reactions to the examinations were reported.

Conclusions

Scintigraphy with 99mTc-anti-TNF-α was well-tolerated and had a good ability to distinguish between inflammatory and noninflammatory lesions in patients with rheumatoid arthritis.
Prognostic value of imaging-based parameters in patients with intermediate-stage hepatocellular carcinoma undergoing transarterial radioembolization
Authors: Puranik Ameya D. , Rangarajan Venkatesh , Gosavi Atul , Shetty Nitin , Gala Kunal , Kulkarni Suyash , Mohite Ashish , Patkar Shraddha , Goel Mahesh , Shrikhande Shailesh V. , Ramaswamy Anant , Ostwal Vikas , Purandare Nilendu C. , Agrawal Archi , Shah Sneha
Published: December 2020

Objective

Patients with inoperable multilobar hepatocellular carcinoma (HCC) Barcelona Clinic Liver Cancer (BCLC) stage B, who have failed other liver-directed treatment options, are ideal candidates for transarterial radioembolization (TARE) with Yttrium-90 (Y-90)-labeled glass spheres. There is limited data regarding variables that impact the prognosis and outcome in these patients. 99mTc-MAA scan for lung shunt fraction (LSF) and 18F-FDG PET/CT are performed during initial workup. We, therefore, decided to assess the prognostic impact of LSF and metabolic parameters, such as maximum SUVmax, MTV and TLG in patients undergoing TARE for HCC.

Methods

We retrospectively analyzed 64 patients of HCC, between January 2010 and December 2016, deemed suitable for TARE. Pre-TARE LSF was computed on 99mTc MAA scan, and SUVmax, MTV and TLG on fluoro-deoxyglucose positron emission tomography/computed tomography were measured using automated software by 3D region of interest. LSF and PET parameters were stratified using optimal cut-offs derived from receiver operating curve analysis. Survival curves for the groups were estimated using the Kaplan–Meier method and were compared using log-rank test.

Results

Overall survival (OS) was 15 months. In univariate analysis, high LSF (greater than 7.19), MTV and TLG were statistically significant and were associated with poor OS. In multivariate analysis, TLG (P value 0.044), MTV (P value 0.290) and LSF (P value 0.010) were independent predictors of outcome, after adjustment for significant univariate variables. However, SUVmax was not statistically significant for OS.

Conclusions

LSF, MTV and TLG are significant independent prognostic indicators of outcome in patients undergoing TARE for HCC.
Sex difference in cerebral blood flow and cerebral glucose metabolism: an activation-likelihood estimation meta-analysis
Authors: Shin Seunghyeon , Kim Keunyoung , Nam Hyun-Yeol , Kim In Joo , Pak Kyoungjune
Published: December 2020

Objectives

Sex differences exist in a variety of aspects including neurochemicals as well as behavioral traits of cognition, language, and aggression. We performed a meta-analysis of studies using a coordinate-based technique of activation-likelihood estimation (ALE) to identify the pooled estimated effect of sex difference.

Methods

We performed a systematic search of MEDLINE and EMBASE for English-language publications using the keywords of ‘positron emission tomography (PET)’, ‘single-photon emission computed tomography (SPECT)’, and ‘sex’. A threshold of uncorrected P < 0.001 (minimum volume of 200 mm3) was applied to the resulting ALE map.

Results

Cerebral blood flow (CBF) in right precuneus, left superior temporal gyrus, left inferior temporal, left inferior frontal gyrus, right cerebellar tonsil, and right middle temporal gyrus was higher in females than males. CBF in left anterior cingulate was higher in males than females. Whereas, the cerebral metabolic rate for glucose (CMRglu) in left thalamus, left cingulate gyrus, right inferior parietal lobule, left medial frontal gyrus, right middle frontal gyrus, right midbrain, and left inferior parietal lobule was higher in females than males. However, there was no brain region that showed higher CMRglu in males than females.

Conclusion

Regional CBF and CMRglu from PET and SPECT showed the difference between males and females.
Varied Presentations and Comorbidities in Pediatric Autoimmune Pancreatitis
Authors: Suter Blair , Patel Feenalie , Holland Kathleen , Brown Brandon P. , Bhatt Heli , Puri Kanika , McFerron Brian , Vanderpool Charles
Published: December 2020

Autoimmune pancreatitis (AIP) is a chronic inflammatory condition rarely reported in children. In 2018, to standardize the approach to AIP, INternational Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) defined AIP, outlined the clinical course, and developed diagnostic and therapeutic recommendations. We performed a retrospective review of cases at our institution from January 1, 2016, to June 1, 2019, and compared their presentations with the INSPPIRE guidelines. Our patients showed variable laboratory, radiographic, and histologic findings, highlighting the difficulty in diagnosing AIP. Histologic samples were obtained in our patients due to diagnostic uncertainty, which ultimately confirmed the diagnosis. One patient was diagnosed with autoimmune hepatitis coexistent with AIP, which has not been previously described in the pediatric population. Exocrine and endocrine complications of AIP were also noted. In all cases, symptoms improved following treatment, and decompression of the common bile duct was seen on repeat imaging.